Cognizant is seeking a NetworX Product Consultant to work with Facets and NetworX (Pricer & Modeler) to support the implementation, enhancement, maintenance, and issue resolution for a fast-growing Health Plan client. This role requires extensive communication, technical configuration, system testing, and collaboration with technical and business teams to ensure alignment with client objectives.
What You'll Do
- Lead and manage the implementation and configuration of NetworX pricing agreements to support health plan operations.
- Serve as a subject matter expert, providing guidance on best practices, troubleshooting, and issue resolution.
- Comprehend contracts, regulations, provider bulletins, and other provider reimbursement-related policies.
- Collaborate with cross-functional teams, including IT, claims, provider services, and business operations, to implement and enhance system configurations.
- Develop, document, and maintain configuration standards, policies, and procedures.
- Analyze and validate system configurations to ensure accurate claim adjudication and provider reimbursement.
- Identify opportunities for system enhancements and automation to improve efficiency and reduce errors.
- Support system testing, upgrades, and implementations to ensure seamless transitions and minimal disruption.
- Collaborate with solution architects and technical teams to ensure integration and alignment with business goals.
- Lead and participate in design and configuration review sessions to ensure adherence to standards and best practices.
- Provide clear communication on implementation status, risks, and solutions.
- Provide training and knowledge transfer to internal teams and stakeholders.
- Provide a deep understanding of Agile Scrum processes and working methodology.
What We're Looking For
- Over 10 years of active, hands-on experience with Facets, NetworX Pricer & Modeler, OPTUM Grouper Pricer products, Claims processing, and US Healthcare.
- Over 10 years of experience in a project leadership role, operating in an onsite-offshore model.
- Over 10 years of experience in building tools and strategies for automation, optimization, and digital transformation.
- Proven experience in configuring and managing implementations, enhancements, and maintenance, including New LOB implementations.
- Expertise in system configuration and strong understanding of the healthcare industry and managed care concepts.
- Proficiency in writing and optimizing SQL queries for data manipulation, extraction, and reporting.
- Proficiency in reimbursement methodologies and the ability to interpret these through requirements and design.
- Demonstrated ability to research, analyze, design, and build Facets Provider configuration, understand Optum PPS configuration, and interpret payer-provider contract terms.
- Demonstrated ability to manage system-related projects from inception to closure.
- Excellent written and verbal communication skills.
- Strong understanding of healthcare claims processing, provider contracts, fee schedules, and benefits configuration.
- Knowledge of health plan operations for Medicare, Medicaid, Marketplace, LTSS, DSNP (duals) is mandatory.
- Proficiency in troubleshooting system and configuration issues, with a focus on root cause analysis.
- Configuration expertise on Facets Version 25.R1 (or higher) on an SQL platform.
- Knowledge of Windows, Microsoft Office, Project Management Tools, Query Tools (SQL, Cognos, etc.), and the administration of Packaged Claims Processing Applications.
- Ability to adapt to a constantly changing environment, handle pressure, and work in a fast-paced environment, both independently and collaboratively.
Nice to Have
- Bachelor’s degree in Business, Finance, Mathematics, Operations Research, Computer Science, Data Science, or a related field.
- Experience with large configuration projects.
- Understanding of technical languages such as C#, Python, HTML, JavaScript, and CSS.
- Experience with version control and managing source code repositories using Azure DevOps, Jira, GitHub, etc.
- Familiarity with MS Excel, CoPilot, Power Automate, and ChatGPT for data analysis and reporting.
Technical Stack
- Core: Facets, NetworX Pricer, NetworX Modeler, OPTUM Grouper Pricer
- Data & Query: SQL, Cognos
- Platform & Tools: Windows, Microsoft Excel, PowerPoint, Word, Project Management Tools
- Development & DevOps: Azure DevOps, Jira, GitHub, C#, Python, HTML, JavaScript, CSS
- Productivity: MS Excel, CoPilot, Power Automate, ChatGPT
Benefits & Compensation
- Medical/Dental/Vision/Life Insurance
- Paid holidays plus Paid Time Off
- 401(k) plan and contributions
- Long-term/Short-term Disability
- Paid Parental Leave
- Employee Stock Purchase Plan
- Compensation: $113K-$132K
Work Mode
This is a fully remote position open to candidates located within the United States.
Cognizant is an equal opportunity employer.
