Business Systems Analyst (FACETS Provider)

Role: Business Systems Analyst (FACETS Provider)
Location: Seattle, WA
Type: Long Term Contract
 
Job Description:
Seeking an experienced Business Systems Analyst (BSA).
Provider with deep expertise in the TriZetto FACETS Provider platform, including Provider Configuration, Network Management, and Pricing. 
This role will serve as a Subject Matter Expert (SME) supporting strategic Healthcare Payer initiatives, FACETS implementations, regulatory mandates, system enhancements, and upgrade programs. 
The ideal candidate will possess strong knowledge of FACETS Provider modules, provider network management, reimbursement and pricing methodologies, batch processes, backend data models, and advanced SQL analysis. 
The candidate will partner with business stakeholders, provider operations teams, architects, developers, and testing teams to deliver high-quality solutions across the provider domain. 
Serve as the primary Business Systems Analyst and SME for FACETS Provider, Network, and Pricing initiatives. 
Gather, analyze, document, and validate business and system requirements related to provider operations and reimbursement processes. 
Collaborate with business and technical stakeholders to translate provider network and pricing requirements into scalable system solutions. 
Perform impact analysis for regulatory mandates, enhancements, system upgrades, and modernization initiatives. 
Analyze end-to-end provider lifecycle processes, including provider setup, credentialing integrations, contracting, network participation, and reimbursement methodologies. 
Support FACETS implementation, migration, upgrade, and transformation programs. 
Develop business requirements documents, functional specifications, process flows, use cases, and data mapping documentation. 
Conduct root cause analysis and recommend solutions for complex provider and pricing-related issues. 
Partner with development, QA, architecture, and support teams throughout the SDLC lifecycle. 
Support User Acceptance Testing (UAT), defect triage, deployment validation, and post-production support activities. 
Facilitate stakeholder meetings, solution workshops, and business process discussions. 
Provide production support expertise for provider configuration, network management, and pricing-related issues. 
Required Qualifications Experience 10+ years of experience as a Business Systems Analyst or Business Analyst. 
Minimum 5+ years of hands-on experience with the TriZetto FACETS platform. 
Extensive Healthcare Payer domain experience. 
Proven experience supporting complex FACETS implementations, regulatory mandates, and upgrade initiatives.
Required Skills SME-level expertise in: FACETS Provider Module 
Provider Configuration & Maintenance 
Provider Network Management 
Contracting & Reimbursement Models 
Pricing Configuration 
FACETS Front-End Functionality 
FACETS Batch Processing 
FACETS Backend Data Models
Strong understanding of Healthcare Payer provider operations and network management processes. 
Advanced SQL skills with the ability to write complex queries for analysis, data validation, troubleshooting, and solution design. 
Experience analyzing provider network, contracting, fee schedule, pricing, and reimbursement business processes. 
Strong requirements gathering, business process analysis, and solutioning capabilities. 
Experience creating functional specifications, business rules, gap analysis, and system documentation.
Excellent communication, stakeholder management, and facilitation skills. 
Ability to effectively collaborate with business, operational, and technical teams. 
Preferred Qualifications Business Analysis certifications such as: CBAP (Certified Business Analysis Professional) 
CCBA (Certification of Capability in Business Analysis) 
PMI-PBA (Professional in Business Analysis) 
Experience supporting healthcare regulatory and compliance initiatives. 
Familiarity with Agile delivery methodologies and tools such as JIRA, Azure DevOps, and ServiceNow. 
Exposure to Claims, Membership, Billing, and Core FACETS Administration functions. 
Key Competencies: Provider Network Management Expertise 
Pricing & Reimbursement Knowledge 
FACETS Subject Matter Expertise 
Complex SQL & Data Analysis 
Requirements Elicitation & Documentation 
Business Process Modeling 
Solution Design & Validation Stakeholder Management 
Root Cause Analysis Agile & Waterfall Delivery