Note: The job is a remote job and is open to candidates in USA. IMCS Group is seeking a Senior Facets / Java Developer to implement state-specific Medicaid regulatory changes across Facets and related healthcare applications. The role translates regulatory and business requirements into system configuration, application changes, integrations, and data-processing solutions in collaboration with regulatory, business, architecture, and QA teams.
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
Skills
- 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
- Knowledge of automated CI/CD, code quality and test automation practices
- 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
Benefits
- Remote
Company Overview
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