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
• Eligibility
• Benefits
• Claims
• Claims 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