Job Description & Details
This is a niche healthcare payer role where you will live and breathe NetworX Pricer, Modeler, and FACETS configurations. If you know how provider contracts actually translate into system fee schedules and reimbursement methodologies, this gig will feel very familiar.
What You'll Actually Be Doing
You will spend your days translating complex provider contracts into precise system configurations within the NetworX platform. This isn't just data entry; it requires deep analytical work to ensure fee schedules, qualifier groups, and pricing methodologies are set up correctly. You'll also be troubleshooting claims adjudication failures, working closely with the claims and IT teams, and running validation tests to make sure providers get paid accurately the first time.
The Core Tech Stack
You absolutely must have hands-on experience with NetworX Pricer and NetworX Modeler, alongside FACETS claims adjudication knowledge. The team relies on you to understand healthcare provider reimbursement models inside and out—ranging from standard fee schedules to complex risk-sharing and value-based contracts. If you don't already know how provider contracts drive backend system logic in FACETS, the learning curve here will be steep.
Interview Expectations
Expect the hiring manager to throw a messy, real-world provider contract scenario at you and ask how you would configure the reimbursement methodology in NetworX. They want to see your step-by-step logic, specifically how you handle edge cases like secondary pricing or tiered fee schedules. They are also going to test your FACETS claims troubleshooting process to see how you isolate whether an incorrect payment is due to a contract setup error or a downstream adjudication bug.
Application Advice
Your resume needs to make your healthcare payer background impossible to miss. Skip the generic IT buzzwords and explicitly list your experience with NetworX Pricer, Modeler, and FACETS configuration right at the top. Use keywords directly from the job description like 'provider contract configuration', 'reimbursement methodologies', and 'fee schedules' so you easily clear the initial ATS filters.