Facets Configuration Analyst Resume Baltimore, MD - Hire IT People

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:

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: