Facets Process & Documentation Specialist
Skills
Business ProcessClaims ProcessingDocumentationIT EscalationJob PostingsMedicaidPayer
What the job involves
The main requirements, responsibilities and hiring steps.
Requirements
- 5+ years working in healthcare payer operations
- 5+ years healthcare payer experience with Medicare and Medicaid
- 5+ years hands-on experience with claims systems such as Facets QNXT or HealthRules
- Experience in premium billing claims processing benefits and provider configuration
- Strong experience developing DLPs SOPs workflows or operational documentation
- Deep understanding of eligibility premium billing claims adjudication and benefits configuration
- Proven ability to translate complex processes into clear step-by-step instructions
- Proven ability to troubleshoot and resolve system or process related issues
- Experience working in a consulting or client-facing environment
- Experience building training materials or user guides
- AI tools experience with Copilot ChatGPT or Claude
Nice to have
- detail-oriented
- analytical
- collaborative
- process-driven
- client-focused
Day to day
- Design and document desk level procedures for healthcare payer operations using Facets and related systems.
- Translate complex membership claims benefits and provider workflows into clear step-by-step documentation for operational teams.
- Partner with claims enrollment IT and operations teams to troubleshoot issues identify root causes and improve process consistency.