Facet Java Developer

Excelon Solutions; United States; On-site; USD 120,000 - 180,000; Full time

Job summary

Excelon Solutions is seeking a skilled healthcare IT engineer to analyze Medicaid regulatory requirements and translate them into technical changes across Facets and supporting applications.

You will design, develop, configure, and maintain enrollment, eligibility, benefits, and claims processing solutions, plus build Java-based applications, interfaces, and ETL components using IBM DataStage and Talend. Strong regulatory and payer domain knowledge is essential.

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Qualifications

• 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.
• Membership
• Claims
• Claims adjudication
• 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

Responsibilities

• Analyze regulatory changes and translate them into technical changes across Facets and related applications.
• Design, develop, configure, and maintain solutions for enrollment, eligibility, membership maintenance, benefits, claims, and provider claims processing.
• Develop and enhance Java-based applications, APIs, interfaces, batch programs, and integration components for Facets.
• Develop or modify Mainframe programs and batch-processing components supporting Medicaid processes.
• Perform Facets configuration and development for 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 and data platforms.
• Conduct code reviews, unit testing, defect resolution, root-cause analysis, and quality assessments.
• Support system integration testing, regression testing and production implementations.
• Troubleshoot complex claims, eligibility and regulatory processing issues.
• Create reusable engineering approaches for state-specific variations and regulatory requirements.

Skills

TriZetto Facets

Java/J2EE

ETL/DataStage

Talend/TalendWorks

Medicaid regulatory requirements

Regulatory changes in payer platforms

Membership

Claims

Claims adjudication

Medicaid/Medicare processes

SQL and data integration

Debugging & root-cause analysis

Tools

TriZetto Facets

Java/J2EE ecosystem

IBM DataStage

Talend/TalendWorks

SQL

Job description

• 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.
• Membership
• Claims
• Claims adjudication
• 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