Provider Subject Matter Expert (SME) - Payer Side at Remote

Hi , Hope you are doing well Please find the Job Description (JD) below. Role: Provider Subject Matter Expert (SME) - Payer Side Location : Remote Module / focus area: Provider (domain and strategic) Contract or FTE open for both Role summary Serve as the go-to domain expert on provider operations, contracting, credentialing, and network management for a health plan or payer organization. You will guide FACETS configuration decisions, business process design, and cross-functional initiatives from a provider-first lens. This is a strategic, advisory role: less hands-on FACETS screen configuration, more ownership of provider domain knowledge, contract interpretation, and guidance on what should be configured and why. It is typically a senior individual contributor position within Provider Network Operations or a Payer Configuration COE. Key responsibilities Act as the primary subject matter authority on the provider lifecycle: onboarding, credentialing, contracting, network adequacy, and termination Advise configuration and IT teams on how provider contract terms, fee schedules, and reimbursement methodologies should translate into FACETS setup Review and validate provider data accuracy across systems (FACETS, provider data management tools, credentialing platforms) Support network strategy discussions, including network adequacy, tiering, and narrow versus broad network design Lead root-cause analysis on provider-related claims payment discrepancies, escalations, and disputes Partner with Legal and Contracting teams to interpret provider agreements and ensure system configuration reflects contract intent Provide training and guidance to configuration analysts, claims teams, and customer service on provider-related policies Support regulatory and compliance audits related to provider data (CMS, NCQA, state DOI) Participate in vendor and system implementations, upgrades, and provider data migrations as the business and domain expert Required qualifications 6+ years of experience in provider network management, provider contracting, or provider operations at a health plan or payer; workflow experience is a must Deep understanding of provider reimbursement methodologies (fee-for-service, capitation, value-based care, DRG, RBRVS) Strong knowledge of provider credentialing and NCQA/CMS credentialing standards Experience with FACETS or similar core administration platforms (QNXT, Xcelys) from a business or functional standpoint Ability to translate contract language into system and business rule requirements Strong analytical skills, with comfort digging into claims and provider data to identify root causes Experience collaborating with IT and configuration teams to bridge business and technical requirements Preferred qualifications Experience with value-based care (VBC) contract design and configuration Familiarity with provider data management (PDM) or Master Data Management (MDM) tools Exposure to provider portal or provider self-service platform requirements Experience supporting network adequacy filings or state/CMS network reporting Prior experience as a Provider Configuration Analyst or Provider Contracting Manager Six Sigma or process improvement certification Experience in multi-state or multi-line-of-business payer environments (Medicare Advantage, Medicaid, Commercial, ACA) Thanks and Regards, Madhu Challa | Sr. Technical recruiter Propelsys Technologies | 4975 Preston Park Boulevard, Suite 70 West Plano, TX 75093 M: E: