FACETS trained (+ 2 years) experienced staff in working daily issues overall with provider data for Flexlink product as well as our other Commercial and TPA business in reviewing adds/changes or deletes to provider data
Ability to work off of Excel spreadsheets (or Google sheets), follow current procedures, meet quality and productivity standards to support the daily business needs
Ability to also perform some testing or QA to validate and verify data
FACETS trained (+ 2years) experienced claims examiner familiar with Flexlink claims, processes and adjustments to work on current team to support business functions for payment.
Ability to follow instructions and work with high level of accuracy and precision for claims, adjustments.
Also, with the ability to challenge/question how the claims are working (errors, pricing, issues).
Ability to work from Excel reports (and Google sheets) and maintain production expectations.
Work with current BA to collect, analyze business requirements to develop requirements for a comprehensive reporting package and dashboard that includes attentiveness to SLA’s within the organization, with clients, and with vendors
Data will include thresholds that will be the baseline of escalation, trends, and accurate data presentation
Will need strong analytical skills, FACETS knowledge (2 + years) business acumen and understanding of Tableau for requirements gathering and approval
Provide manual execution of test cases compared to defined requirements and system functionality that pass business expectation
Traceability to requirements is a must have Health Care operations knowledge for claims, authorization, enrollment, and benefits to properly analyze end results
Results include discussions with customer (business) to fully understand product specifications and results to modify as needed to obtain expected results
Requires critical thinking, question asking, strategic perspective for long term solutions
Must have knowledge of FACETS (minimum 2 years) strong business acumen, be collaborative, thorough, organized with the ability to work in a fast paced environment
Experienced Solution Architect with Strong Business and Technical skills that enable to meet business and regulatory requirements on a cross functional basis.
Experience with more than 10 or more years of experience in delivering high-impact solutions in the areas of Healthcare-Payor and provider industry in planning, business intelligence, Facets Product and surrounding eco-systems.
Track Record of establishing credibility with customers and delivering successful projects.
Planning and Business Intelligence
Project Management, Scoping, and Requirements gathering
Solution and financial impact analysis (ROI)
Understanding Agile project management and SDLC
Business Application Implementation
Enterprise solutioning of surrounding applications and platforms to Facets
Expert knowledge base in Facets 6.0 and higher
Expert knowledge base in Facets Core Batch architecture with core and custom functionalities
Facets Eco Systems and integration with Core Facets
EDI knowledge base of 834, 270/271, 837I, 837P, 835, 278(I/O)
Facets Workflow Process
Knowledge base of custom and staging DB in Facets Core
Applications: Cognizant Facets 5.6r1 and higher, Facets HIPPA Gateway, MS SQL
