Job Description :
Summary of Opportunity

Cohesion has an immediate need for two Facets Configuration Analysts for a six-month contract with our client in downtown Dayton. This individual will provide subject matter expertise for technical guidance, training and direction with a team of development professionals.


Skills and Experience Required:
1. Facets configuration for design and development of NetworX/Provider Agreements
2. SQL
3. Access

Job Responsibilities:
1. Lead and define system requirements associated with Member Benefits, Provider Reimbursement and payment systems requirements definition, documentation, design, testing, training and implementation support using appropriate templates or analysis tools.
2. Identify, manage and document the status of open issues. Develop and utilize reports to analyze and stratify data in order to address gaps and provide answers to issues identified within the department or by other departments, utilizing TriZetto or Optum for research and correction.
3. Utilize available tools provided by relevant State or Federal websites to obtain pertinent Fed/State Regulatory Transmittals and Fee Schedules.
4. Plan/implement new software releases including testing and training.
5. Participate in meetings with business owners and users to achieve a Plan benefit design and Provider Reimbursement. Serve as liaison between IT and business areas to research requirements for IT projects, meet with decision makers to translate IT specifications and define business requirements and system goals.
6. Lead review of benefits or provider reimbursement as well as identify and design appropriate changes. Lead in the development and execution of test plans and scenarios for all benefit or reimbursement designs and for the core business system and related processes.
7. Provides detail analysis of efficiencies related to system enhancement/automation. Review, analyze, and document the effectiveness and efficiency of existing systems and develop strategies for improving or further leveraging these systems. Conduct preliminary studies to define needs and determine feasibility of system design.
8. Audit configuration to ensure accuracy and tight internal controls to minimize fraud and abuse and overpayment related issues.
9. Ensure system processes and documents exist as basis for system logic.
10. Assists in resolution for potential business risk, including communication and escalation as necessary.
11. Vendor management between TriZetto and CareSource.
12. Applies use of tools to define requirements such as data modeling, use case analysis, workflow analysis and functional analysis.