Facet Java Developer
Key Responsibilities:
- Analyze regional/state Medicaid regulatory requirements and translate them into technical changes across Facets and surrounding applications.
- Design, develop, configure, and maintain solutions supporting: Member enrollment and eligibility
- Membership maintenance
- Benefits and plan configuration
- Claims intake and adjudication
- Claims pricing and payment
- Provider-related claim processing
- Medicaid-specific edits and business rules
- Medicare/Medicaid coordination where applicable
- Develop and enhance Java-based applications, APIs, interfaces, batch programs, and integration components supporting Facets.
- Develop or modify Mainframe programs and batch-processing components supporting Medicaid processes.
- Perform Facets configuration and development associated with regulatory and business-rule changes.
- Build and maintain ETL/data integration solutions using IBM DataStage and Talend/TalendWorks.
- Analyze upstream and downstream impacts of regulatory changes across Facets, data platforms, interfaces, and surrounding applications.
- Conduct code reviews, unit testing, defect resolution, root-cause analysis, and technical quality assessments.
- Support system integration testing, regression testing and production implementation.
- Troubleshoot complex claims, membership, eligibility, and regulatory processing issues.
- Develop reusable engineering approaches where regulatory requirements are common while accommodating state-specific variations.
- Maintain technical specifications, mappings, configuration documentation, traceability and implementation artifacts.
Required Experience:
- Strong hands-on experience with TriZetto Facets.
- Strong Java/J2EE engineering and programming skills.
- Experience with IBM DataStage and Talend/TalendWorks or comparable enterprise ETL technologies.
- Strong understanding of Medicaid managed-care operations and state-specific regulatory requirements.
- Experience implementing regulatory or business-rule changes within healthcare payer platforms.
- Strong Facets experience in: Membership
- EligibilityBenefitsClaimsClaims adjudication
- Pricing/payment processing
- Good understanding of both Medicaid and Medicare health-plan processes.
- Experience with SQL, databases, batch processing, APIs/interfaces and data integration.
- Strong debugging, production support and root-cause-analysis skills.
- Ability to interpret business/regulatory requirements and convert them into detailed technical solutions