Healthcare System Analyst, Payer Systems | Lorven Technologies
Overview
You will own the end-to-end analysis of healthcare payer systems, focusing on Eligibility & Enrollment, Provider Contract Pricing, and Claims Adjudication. You will bridge business and technical teams, translating complex requirements into SQL and .NET solutions. You will work with Facets platform data models and architecture to drive process improvements. This role stands out for its dual focus on healthcare operations and full-stack technical implementation.
What You'll Do7
- 1Map current-state eligibility and enrollment workflows, then redesign them for Facets integration.
- 2Analyze provider contract pricing logic and configure SQL queries to validate fee schedules.
- 3Debug claims adjudication issues by tracing data through Facets and .NET components.
- 4Design billing and appeals processes with SQL stored procedures and .NET modules.
- 5Collaborate with developers to translate business rules into Facets data model changes.
- 6Own testing and validation of payer system updates, ensuring Facets data integrity.
- 7Document architecture and flow for claims and billing modules, focusing on Facets schemas.
Requirements7
- 13+ years experience as a system analyst in healthcare payer or managed care environments.
- 2Expertise in SQL queries, joins, and data analysis for healthcare claims.
- 3Hands-on experience with Facets platform data models and architecture.
- 4Working knowledge of .NET full-stack development (C#, ASP.NET, and MVC).
- 5Understanding of eligibility, enrollment, provider contracts, and claims adjudication rules.
- 6Familiarity with standard healthcare transaction formats (EDI 270/271, 835, 837).
- 7Strong analytical skills to troubleshoot and resolve complex system issues.
Salary Insight
Salary not disclosed in listing
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