[Remote] Program Manager - PRGMGR
Note: The job is a remote job and is open to candidates in USA. Apolis is recruiting for a NetworX Configuration Analyst supporting healthcare pricing and claims configuration. The role configures and maintains complex pricing logic, translates provider contracts into system rules, leads testing and conversion activities, audits configuration data with SQL, and coordinates with leadership, claims operations, and legal teams.
Responsibilities
- Configure, maintain, and model complex pricing logic within the TriZetto Facets Integrated NetworX Pricer software system
- Translate managed care provider contract language into precise fee schedules, rate sheets*** and system qualifiers
- Manage day-to-day configuration workflows, mentor configuration analysts, and coordinate system conversion projects across platforms
- Direct comprehensive unit, regression, and end-to-end testing processes to ensure absolute claim payment accuracy
- Utilize advanced SQL queries and relational databases to audit, validate, and troubleshoot massive configuration data batches
- Establish hierarchical system logic to correctly prioritize specific provider agreements over standard, regional fallback rates
- Monitor and implement quarterly pricing component updates to maintain strict compliance with CMS, Medicare, and Medicaid rules
- Act as the primary liaison between Configuration of leadership, claims operations, and the legal contracting team
Skills
- Must have hands on experience in NetworX Pricer (5-6 yrs)
- NetworX Configuration (Integrated NetworX)
- Oracle SQL
- Review contract, Agreement testing, migration, assignment
- Configure, maintain, and model complex pricing logic within the TriZetto Facets Integrated NetworX Pricer software system
- Translate managed care provider contract language into precise fee schedules, rate sheets and system qualifiers
- Manage day-to-day configuration workflows, mentor configuration analysts, and coordinate system conversion projects across platforms
- Direct comprehensive unit, regression, and end-to-end testing processes to ensure absolute claim payment accuracy
- Utilize advanced SQL queries and relational databases to audit, validate, and troubleshoot massive configuration data batches
- Establish hierarchical system logic to correctly prioritize specific provider agreements over standard, regional fallback rates
- Monitor and implement quarterly pricing component updates to maintain strict compliance with CMS, Medicare, and Medicaid rules
- Act as the primary liaison between Configuration of leadership, claims operations, and the legal contracting team
- Facets is not required, but nice to have
Benefits
- Remote work – EST, with flexibility if the candidate is strong
Company Overview
Company H1B Sponsorship