Role Summary
An experienced Facets / Mainframe / Java Developer or Engineer to support implementation of state-specific Medicaid regulatory changes across Facets and surrounding healthcare applications.
The engineer will work with regulatory, business, architecture, and QA teams to translate Medicaid requirements into system configuration, application changes, integrations, and data-processing solutions. The ideal candidate combines strong Facets claims and membership knowledge with hands-on Java engineering, DataStage/Talend experience, Mainframe and Medicaid managed-care domain expertise.
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:
o Member enrollment and eligibility
o Membership maintenance
o Benefits and plan configuration
o Claims intake and adjudication
o Claims pricing and payment
o Provider-related claim processing
o Medicaid-specific edits and business rules
o 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:
o Membership
o Eligibility
o Benefits
o Claims
o Claims adjudication
o 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.
Preferred
Medicare-Medicaid / dual-eligible experience.
Experience working with multiple state Medicaid programs.
Experience supporting large health plans or Medicaid MCO environments.
Healthcare EDI/X12 knowledge.
Knowledge of automated CI/CD, code quality and test automation practices."
