Note: The job is a remote job and is open to candidates in USA. Kodeva LLC is seeking a Facets CCA Consultant who will act as a Configuration Subject Matter Expert (SME) in the healthcare payer domain. The role involves analyzing business requirements, designing, configuring, and implementing healthcare payer system configurations to support claims processing and benefits.
Responsibilities
- Analyze business requirements and translate them into system configuration solutions
- Configure healthcare payer applications based on business and regulatory requirements
- Design and maintain benefit plans, provider contracts, pricing, claims, eligibility, and authorization configurations
- Perform impact analysis for new enhancements, system upgrades, and production changes
- Troubleshoot configuration-related issues and provide root cause analysis
- Collaborate with Business Analysts, Developers, QA teams, and business stakeholders throughout the Software Development Life Cycle (SDLC)
- Prepare configuration documentation, technical specifications, and process documents
- Support User Acceptance Testing (UAT), System Integration Testing (SIT), and production validation
- Ensure compliance with healthcare regulations including HIPAA, CMS, and state-specific requirements
- Participate in release planning, deployment, and post-production support
- Mentor junior configuration analysts and provide subject matter expertise
- Support audits, regulatory compliance activities, and production issue resolution
- Resolve configuration defects within SLA
- Perform production impact analysis
- Support incident, problem, and change management activities
- Coordinate production deployments
- Conduct post-implementation validation
- Document lessons learned and best practices
Skills
- Bachelor's degree in Computer Science, Information Systems, Healthcare Administration, or a related field
- 7–12+ years of experience in healthcare payer systems
- 5+ years of hands-on configuration experience
- Experience working with cross-functional teams
- Strong analytical and problem-solving skills
- Excellent communication and stakeholder management skills
- Healthcare payer domain expertise
- Claims processing lifecycle
- Benefits configuration
- Provider contract configuration
- Pricing and reimbursement methodologies
- Member eligibility configuration
- Authorization and referrals
- Enrollment processes
- Medicare and Medicaid knowledge
- Commercial health insurance products
- Experience with healthcare platforms such as Facets, QNXT, HealthRules, or similar payer systems
- Configuration management
- SQL for data validation and troubleshooting
- XML and EDI transactions (837, 835, 834, 270/271)
- SDLC and Agile methodologies
- Jira, Azure DevOps, or similar project management tools
- Microsoft Excel and reporting tools
Company Overview
Company H1B Sponsorship