W2 HOURLY ONLY (NO H1B OR 3RD PARTY VENDOR)

Overview:
We are seeking a highly skilled NetworX Lead with strong Configuration an Team Lead experience in health plan operations and healthcare systems. The ideal candidate will possess deep knowledge of NetworX Lead with strong Configuration and Team Lead experience ensuring optimal system performance, accuracy, and compliance. This role requires strong analytical skills, problem-solving abilities, and expertise in healthcare claims processing, provider network management, and system configuration.

Key Responsibilities:

• Lead and manage the implementation and NetworX Lead with strong configuration experience pricing agreements to support health plan operations.
• Serve as a subject matter expert, providing guidance on best practices, troubleshooting, and issue resolution.
• Experience leading and managing configuration teams.
• 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.
• Provide training and knowledge transfer to internal teams and stakeholders.

Qualifications:

• 5+ years of experience as a NetworX Lead with strong configuration and Team Lead experience in a healthcare or health plan environment.
• Strong understanding of healthcare claims processing, provider contracts, fee schedules, and benefits configuration.
• QNXT or Facets experience is a plus.
• Knowledge of health plan operations for Medicare, Medi-Cal, DSNP (duals) is highly preferred.
• Proficiency in troubleshooting system and configuration issues, with a focus on root cause analysis.
• Experience working with SQL and data analysis tools is a plus.
• Ability to manage multiple tasks, meet deadlines, and work collaboratively in a fast-paced environment.
• Excellent communication and stakeholder management skills.
• Bachelor’s degree in Healthcare Administration, Information Systems, Business, or related field (or equivalent experience).

Required Qualifications:

• NetworX Configuration Lead/SME
• Strong experience as a Team Lead.
• Certifications related to NetworX preferred, but not required as long as candidates meets qualifications and can handle responsibilities.
• QNXT with NetworX configuration, a plus.

• Lead and manage the implementation and NetworX Lead with strong configuration experience pricing agreements to support health plan operations.
• Serve as a subject matter expert, providing guidance on best practices, troubleshooting, and issue resolution.
• Experience leading and managing configuration teams.
• 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.
• Provide training and knowledge transfer to internal teams and stakeholders