NetworX Architect - W2 Only

About the role

This remote, W2 position focuses on NetworX design and configuration within the TriZetto Facets Integrated NetworX Pricer software system. The role involves translating managed care provider contracts into precise system logic, ensuring accurate claim payments, and maintaining compliance with regulatory standards.

Responsibilities

• Configure, maintain, and model complex pricing logic within the TriZetto Facets Integrated NetworX Pricer 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 claim payment accuracy.
• Utilize advanced SQL queries and relational databases to audit, validate, and troubleshoot large configuration data batches.
• Establish hierarchical system logic to prioritize specific provider agreements over standard, regional fallback rates.
• Monitor and implement quarterly pricing component updates to maintain compliance with CMS, Medicare, and Medicaid rules.
• Act as the primary liaison between Configuration leadership, claims operations, and the legal contracting team.
• Review contracts, perform agreement testing, migration, and assignment tasks.

Requirements

• 5-6 years of hands-on experience with NetworX Pricer.
• Experience with NetworX Configuration (Integrated NetworX).
• Proficiency in Oracle SQL.

Facet experience is not required but is a plus.