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Facets Configuration Analyst Resume

Baltimore, MD

PROFESSIONAL PROFILE:

  • Sixteen years of experience in the health insurance industry as a Facets Configuration Analyst and Medical Claims Examiner.
  • Most recently, I have worked as a Facets Consultant for many major health care management companies.
  • I have a bachelor’s degree in Biology, and a foundation in medical terminology.

EXPERIENCE AND SKILLS INCLUDE:

  • Group and benefits installation in Trizetto Facets 4.5,4.7,5.2
  • Facets Applications: Medical Plan, Application Support, Billing, Claims Processing, Provider, Subscriber/Member, Utilization Management, NetworX
  • Medical claims analysis and processing
  • Facets Tables and data model
  • Loading Fee Schedules
  • Benefits review and correction in BSBS(Benefit Summary) application
  • Proficient in Word, Excel, Access, Facets 4.5 and 4.7,5.2
  • Knowledge of ICD - 9, CPT and HCPCS codes
  • Strong Interpersonal Skills

PROFESSIONAL EXPERIENCE:

Confidential, Baltimore, MD

Facets Configuration Analyst

Responsibilities:

  • Facets defects troubleshooting
  • Configuration of Product Tables (Service ID’S, Benefit Summaries, Service Payment, Service Rule, Limits, Billing Components, etc.)
  • Claims Testing
  • Run reports and queries to validate configuration
  • Create Benefits Matrices and document Facets configuration

Confidential, Bronx, NY

Facets Configuration Analyst

Responsibilities:

  • Configure Supplemental Tables for ICD10 in Facets system
  • Configuration in Medical Plan, Subscriber/Member, Claims Processing and Billing modules
  • Test configuration through payment of electronic and manual claims to review the ICD10 Configuration
  • Benefit configuration for dual members Medicare-Medicaid in Facets Applications
  • Run Access queries against Facets tables to validate configuration and identify defects
  • Validate current configuration against the Policy Summary of Benefits
  • Troubleshooting of claims errors

Confidential, Richardson, TX

Benefit Installation Analyst

Responsibilities:

  • Configure benefits in TOPS system according to medical policies
  • Claims testing to verify configuration
  • Troubleshooting claims and configuration errors

Confidential, Washington, DC

Facets Configuration Analyst

Responsibilities:

  • Configure Healthy Blue products in Facets system
  • Configuration in Medical Plan, Subscriber/Member, Claims Processing and Billing modules
  • Test configuration through payment of electronic and manual claims
  • Run Access queries against Facets tables to validate configuration and identify defects
  • Benefit configuration for Medicare and Medicaid members in Facets Applications
  • Validate configuration against the Policy Summary of Benefits
  • Troubleshooting of claims errors

Confidential, Albany, NY

Facets Configuration Analyst

Responsibilities:

  • Configure plan/products in Facets
  • Configuration of Product Tables (Service ID’S, Benefit Summaries, Service Payment, Service Rule, Limits, Billing Components, etc.)
  • Claims Testing
  • Run reports and queries to validate configuration
  • Create Benefits Matrices and document Facets configuration

Confidential, Detroit, MI

Facets Configuration Analyst

Responsibilities:

  • Facets configuration including Medical Plan, Subscriber/Member and Claims Processing Applications
  • Create claims test scenarios
  • Configuration of benefits to pay electronic and manual claims

Confidential, Buffalo, NY

Facets Configuration Analyst

Responsibilities:

  • Configure Product Tables (Service ID’S, Service Payment, Service Rule, Limits, SPCT, SRCT, SEDF)
  • Configuration of benefits based on policy
  • Clean up of incorrect configuration
  • Run reports to validate configuration
  • Test claims scenarios

Confidential, Detroit, MI

Configuration Analyst

Responsibilities:

  • Work with the Facets Configuration Team to build over 500 new products
  • Conduct Facets claims testing
  • Run reports to validate configuration
  • Benefit configuration for dual members Medicare-Medicaid in Facets Applications
  • Life Insurance Cooperative Of Puerto Rico San Juan, PR

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