Cognizant · 1 week ago
NetworX Consultant
United States
Full-time
Remote
Senior Level, Lead/Staff
$61K/yr - $108K/yr
10+ years expCognizant is seeking a NetworX Consultant to support the implementation and optimization of system software and tools for a fast-growing Health Plan. The role involves extensive communication and collaboration with technical and business teams to ensure system performance aligns with business goals.
ConsultingIndustrial AutomationInformation TechnologySoftwareSoftware Engineering
No H1B
Responsibilities
Lead and manage the implementation and configuration of NetworX pricing agreements to support health plan operations, including assessment and understanding of provider data
Serve as a subject matter expert, providing guidance on best practices, troubleshooting, and issue resolution
Comprehend contracts, regulations, provider bulletins, and other provider reimbursement-related policies
Collaborate with cross-functional teams, including IT, claims, provider services, and business operations, to implement and enhance system configurations
Develop, document, and maintain configuration standards, policies, and procedures
Analyze and validate system configurations to ensure accurate claim adjudication and provider reimbursement
Identify opportunities for system enhancements and automation to improve efficiency and reduce errors
Support system testing, upgrades, and implementations to ensure seamless transitions and minimal disruption
Conduct system testing and troubleshoot issues to ensure smooth functionality
Collaborate with solution architects and technical teams to ensure integration and alignment with business goals
Lead and participate in design and configuration review sessions to ensure adherence to standards and best practices
Provide clear communication on implementation status, risks, and solutions
Provide training and knowledge transfer to internal teams and stakeholders
Provide a deep understanding of Agile Scrum processes and working methodology
Qualification
Required
Over 10 years of active and hands-on experience with Facets, NetworX Pricer & Modeler, OPTUM Grouper Pricer products, Claims processing, and US Healthcare
Over 10 years of experience in a project leadership role, operating in an onsite-offshore model
Over 10 years of experience in building tools and strategies for automation, optimization, and digital transformation
Proven experience in configuring and managing implementations, enhancements, and maintenance
Expertise in New LOB implementations
Expertise in system configuration and strong understanding of the healthcare industry and managed care concepts
Proficiency in writing and optimizing SQL queries for data manipulation, extraction, and reporting
Proficiency in reimbursement methodologies and the ability to interpret these through requirements and design
Demonstrated ability to research, analyze, design, and build Facets Provider configuration
Demonstrated ability to understand and use Optum PPS configuration
Demonstrated ability to understand and interpret payer-provider contract terms, develop technical design, and implement them in configuration
Demonstrated ability to manage system-related projects from inception to closure
Excellent written and verbal communication skills
Strong understanding of healthcare claims processing, provider contracts, fee schedules, and benefits configuration
Knowledge of health plan operations for Medicare, Medicaid, Marketplace, LTSS, DSNP (duals) is mandatory
Proficiency in troubleshooting system and configuration issues, with a focus on root cause analysis
Configuration expertise on Facets Version 25.R1 (or higher) on an SQL platform
Knowledge of Windows, Microsoft Excel, PowerPoint, and Word, as well as Project Management Tools, Query Tools (SQL, Cognos, etc.), and the administration of Packaged Claims Processing Applications
Ability to adapt to a constantly changing environment and handle pressure situations
Ability to work in a fast-paced environment, both independently and collaboratively
Preferred
Experience with large configuration projects is preferred
Understanding of technical languages such as C#, Python, HTML, JavaScript, and CSS
Experience with version control and managing source code repositories using Azure DevOps, Jira, GitHub, etc
Familiarity with MS Excel, CoPilot, Power Automate, and ChatGPT for data analysis and reporting
Bachelor's degree in Business, Finance, Mathematics, Operations Research, Computer Science, Data Science, or a related field
Benefits
Medical/Dental/Vision/Life Insurance
Paid holidays plus Paid Time Off
401(k) plan and contributions
Long-term/Short-term Disability
Paid Parental Leave
Employee Stock Purchase Plan
Company
Cognizant
Cognizant is a professional services company that helps clients alter their business, operating, and technology models for the digital era.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$0.24MKey Investors
Summit Financial Wealth Advisors
2025-03-08Post Ipo Equity
2016-11-18Post Ipo Equity· $0.24M
1998-06-19IPO
Leadership Team
Ravi Kumar S
Chief Executive Officer
Anil Cheriyan
CTO / EVP Strategy & Technology
Recent News
Indian Express
2026-02-04
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2026-02-03
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2026-02-03
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