TC
Senior Facets Dental Configuration Consultant
TechDigital Corporation
Location not stated
Senior
8 months ago
- SQL
8 months ago
Not enough detail in this posting to match
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Position Overview
We are seeking a highly experienced Senior Facets Dental Configuration Consultant to support dental product configuration, pricing, claims adjudication, and cross functional Facets implementation work for large national payer clients. This role requires deep expertise in Facets Dental modules, clinical and utilization edits, and end to end claims operations. The ideal candidate brings extensive consulting experience, the ability to lead configuration teams, and a strong SME level understanding of dental claims administration.
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Key Responsibilities
Facets Dental Configuration & Implementation
• Configure and maintain Facets Dental applications, including products, benefits, eligibility, provider pricing, customer service, and appeals. end to end implementation cycles.
• Build and validate dental utilization edits, clinical edits, processing control agents, category conversions, and payment methodologies.
• Support configuration across multiple lines of business: Dental, Medical.
Claims Operations & Testing
• Provide SME guidance across claims processing: eligibility, benefits, adjudication, COB, authorizations, customer service, and appeals
• Conduct defect analysis, root cause assessments, and configuration remediation.
Consulting, Leadership & Cross Functional Support
• Facets configuration teams supporting Dental and cross LOB implementations.
• Provide SME support in national payer environments for product design, pricing, and claims transformation initiatives.
• Support utilization based savings initiatives (e.g., improving auto adjudication and reducing manual review).
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Required Qualifications
Facets Dental & Configuration Expertise
• Proven expertise in configuring Facets Dental modules, including:
o Products, benefits, eligibility
o Dental pricing & provider reimbursement
o Dental utilization & clinical edits
o Payment methodologies and claims processing
Claims Processing Knowledge
• Deep understanding of end to end claims lifecycle across Dental, including Ortho and Pedo.
Technical & Testing Competencies
• Experience supporting and executing test plans/scripts across Facets and integrated systems.
• Ability to analyze claims defects, configuration gaps, and operational issues.
Consulting & Leadership Skills
• Experience participating in configuration teams and serving as a Dental SME in large national payer organizations.
• Strong communication skills for collaborating with business stakeholders, IT teams, and external vendors.
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Years of Experience
• 10+ years of Facets configuration and implementation experience (Dental focus aligned with SME level contributions), including dental clinical edits, frequency, and utilization edits.
• 5+ years leading configuration teams,
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Qualifying questions:
Need candidates with similar skills and listed below is a list of questions to determine proficiency.
1. Facets Dental Configuration Skills
Candidate should demonstrate experience in:
• Configuring Facets Dental products across multiple versions (e.g., V6.10, V5.6, V5.3).
• Building and maintaining Dental benefits, products, fee schedules, service groups, categories, and payment rules.
• Setting up Dental clinical edits, processing control agents, procedure/category conversions, payment methodologies.
• Knowledge of Dental UM/UR edits to improve auto-adjudication.
• Experience with Dental provider pricing configuration and variations across payer types.
2. Claims Processing & Adjudication Knowledge
The candidate should understand:
• End to end Dental claims lifecycle (intake ➝ adjudication ➝ payments).
• Benefit adjudication logic, COB rules, benefit limitations, authorization requirements.
• Troubleshooting claims processing errors and identifying root cause configuration defects.
4. Testing Skills (Functional & UAT)
Candidate should have experience in:
• Developing test plans, test cases, and test scripts across Facets modules.
• Executing configuration testing, regression testing, pricing validation, and workflow validation.
• Supporting UAT, analyzing defects, and validating configuration fixes.
5. Multi-Module Facets Knowledge
Preferred experience include:
• Understanding of cross functional impacts between Dental, orthodontia and pre-treatment authorizations
• Familiarity with letter, appeals, authorizations, and pends.
6. Cross-Functional & Leadership Skills
Candidate should show:
• Ability to lead or participate in configuration teams.
• Experience coaching analysts or training internal staff.
• Capability to collaborate with IT, QA, business teams, and external clients across multiple regions.
7. Customer Interaction & SME Skills
Candidate should demonstrate:
• Ability to conduct customer discussions for requirements clarification.
• Experience guiding clients on best practice configuration strategies.
• Comfort representing the Dental configuration function as a subject matter expert.
8. Analytical & Documentation Skills
• Strong ability to document configuration decisions, test results, and process flows.
• Experience performing claims data analysis, root cause investigation, and configuration audit.
• Capability to analyze provider agreements, contract terms, and pricing structures.
9. Tools & Technical Skills
• SQL proficiency for validating configuration and claims behavior.
• Familiarity with Facets Dental data model, and related file structures.
10. Industry Knowledge
Candidate should have:
• Understanding of regulatory and compliance frameworks
• Industry codes sets
Senior Facets Dental Configuration Consultant · TechDigital Corporation