Cognizant is looking for a Senior NetworX/Facets Configuration Consultant to configure, optimize, and support Facets and Optum NetworX (Pricer and Modeler). You will enable accurate, efficient claims adjudication for a fast-growing health plan by translating complex reimbursement policies into high-quality system configurations.
What You'll Do
- Lead and manage NetworX pricing agreement implementation and configuration.
- Serve as a subject matter expert on Facets, NetworX, and reimbursement best practices.
- Interpret contracts, regulations, provider bulletins, and reimbursement policies to translate guidance into configuration updates.
- Collaborate with cross-functional teams to implement and enhance system configurations and integrations.
- Develop, document, and maintain configuration standards, policies, and procedures.
- Analyze and validate configurations to ensure accurate claim adjudication and identify automation opportunities.
- Plan and execute system testing, upgrades, and implementations while communicating status, risks, and mitigation.
- Deliver training and knowledge transfer to internal teams.
What We're Looking For
- 10+ years of hands-on experience with Facets, NetworX Pricer, Optum Grouper/Pricer, claims processing, and U.S. healthcare.
- 5+ years leading projects in an onsite-offshore model, delivering implementations and maintenance at scale.
- Expertise in new line-of-business implementations and end-to-end system configuration.
- Strong knowledge of managed care concepts, provider contracts, fee schedules, and benefit configuration.
- Proficiency writing and optimizing SQL queries for data validation, analysis, and reporting.
- Demonstrated ability to analyze, design, and build Facets Provider configuration with knowledge of Optum PPS configuration.
- Ability to interpret payer-provider contract terms, produce technical designs, and implement them via configuration.
- Deep understanding of health plan operations for Medicare, Medicaid, Marketplace, LTSS, and DSNP.
- Configuration experience on Facets v25.R1 or higher on an SQL platform.
- Excellent communication skills with strong root-cause analysis and issue-resolution abilities.
Nice to Have
- Experience delivering large configuration programs and complex production cutovers.
- Hands-on use of project/portfolio tools and query/reporting tools like Cognos.
- Familiarity with Power Automate, Copilot, and ChatGPT to streamline workflows.
- Ability to thrive in a fast-paced, changing environment, working independently and collaboratively.
Technical Stack
- Facets, Optum NetworX (Pricer/Modeler), Optum Grouper/Pricer
- SQL, Cognos
- Windows, Excel, PowerPoint, Word
- Power Automate, Copilot, ChatGPT
Team & Environment
You will be part of the Healthcare Technology & Operations team, partnering closely with IT, claims, provider services, business operations, and solution architects.
Benefits & Compensation
- Medical, Dental, Vision, and Life Insurance
- Paid holidays plus Paid Time Off
- 401(k) plan and contributions
- Long-term and Short-term Disability
- Paid Parental Leave
- Employee Stock Purchase Plan
- Compensation: $132,000 - $150,000
Work Mode
This is a fully remote position for candidates located in the United States.
Cognizant is an equal opportunity employer.
