Healthcare IS · 2 weeks ago
Facets Configuration SME
United States
Contract
Remote
Senior Level, Lead/Staff
10+ years expHealthcare IS is seeking a Facets Configuration Subject Matter Expert (SME) with deep expertise across core Facets modules. The role involves supporting complex configuration initiatives across claims, provider/payment arrangements, and ensuring operational efficiency and compliance.
ConsultingData IntegrationElectronic Health Record (EHR)Health CarePharmaceutical
Responsibilities
Lead end‑to‑end Facets configuration , including Benefits, Provider, Claims, Pricing, and Workflow components, ensuring accurate system behavior and alignment with business rules
Configure and maintain DOFR rules , financial accountability structures, and division-of-payment logic across delegated entities, IPAs, and health plans
Interpret and translate contract terms, plan documents, and organizational payment models into system‑ready configuration specifications
Collaborate closely with internal business teams—Claims, Finance, Provider Contracting, Delegation Oversight, Enrollment, and IT—to ensure configuration accuracy, alignment, and traceability
Perform configuration testing: UAT, regression, scenario‑based adjudication, DOFR payment validation, and impact analysis
Conduct root‑cause analysis for claims or financial discrepancies related to DOFR, provider pricing, or benefit interpretation
Support downstream and upstream integrations, including pricing engines, delegated entity data exchanges, and reporting datasets
Maintain configuration documentation, version control, job aids, and process playbooks in accordance with Huron standards
Serve as a senior advisor for internal and client teams, offering guidance on Facets best practices, configuration strategy, and optimization
Qualification
Required
10+ years of hands‑on Facets configuration experience across multiple subsystems (e.g., Benefits, Provider, Workflow, Claims)
2+ years of direct DOFR configuration experience, including familiarity with delegated risk models, provider payment allocations, and reconciliation workflows
Strong understanding of claims adjudication, benefit interpretation, reimbursement methodologies, and provider contract logic
Experience working in payer, IPA, MSO, or delegated-risk environments
Proficiency with SQL for troubleshooting, data validation, and configuration analysis
Demonstrated experience supporting system upgrades, release cycles, or new implementation initiatives
Strong analytical, problem‑solving, and documentation skills
Excellent communication skills, with the ability to collaborate across technical and nontechnical stakeholders
Company
Healthcare IS
Healthcare IS is a consulting firm that extends its services in the areas of pharmacy, revenue cycle management and data warehousing.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Catherine Dargin
CPOE Pharmacist Analyst
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