ClaimsXTen Analyst Consultant

posted on July 19, 2017

Job Description

Location: Durham, NC

Duration: 6 Months, Contract to Hire

Job Description:

  • Define CXT rule logic in cross-functional sessions with McKesson, Medical Policy, and TriZetto.
  • Support testing by TriZetto SIT and Topaz QE; coordination and test case support across both testing teams.
  • Manage routine updates to the CXT application (data dictionary, TPIC, code sets) that require promotion through multiple lower regions in the TriZetto hosted environment.
  • Create and track two incident tickets for each change and each set of regions (one for DEV and TEST and one for PPMO and PROD).
  • Coordination with TriZetto Hosting and the Topaz Service Desk.
  • Manage all of the above for any internally generated changes such as Medical Policy code or policy changes.
  • Stay current with operational configuration not only of CXT but of Facets and NetworX pricing.
  • The combination of CXT rule logic and Facets with NetworX pricing require strong knowledge of not only CXT but of claim processing in Facets and NetworX pricing functionality.
  • Faults in CXT rule logic can cause problems with Facets and/or pricing, and vice versa.
  • Troubleshoot issues with CXT (also dependent on a strong understanding of how these applications work together).
  • Respond to inquiries from operational areas who have questions about CXT editing.
  • Work with McKesson and TriZetto at least annually to review rule firing order and logic to ensure optimal configuration.
  • CXT is a complex application that requires deep knowledge of claims, claim processing, claim pricing, and operational the functions of prior authorization, clinical coding and management, and pricing and reimbursement in order to ensure rule content and logic meets multiple business needs (clinical editing, administrative editing, and provider transparency).
  • {Provider transparency is afforded through the sister application to CXT, Clear Claim Connection (C3).}
  • For this request, ClaimsXTen (CXT) experience is most preferred.
  • Will look at applicants who have ClaimCheck or iCES experience.
  • Prefer contract to hire but will look at contract only.

 

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