Facets/EDI Developer II

PacificSource Health Plans•Springfield, OR

1d•Hybrid

About The Position

The Facets/EDI Developer II works within a team to design, develop, and maintain backend services that process complex data, including EDI X12 standards, while ensuring the integrity of data exchanges across internal and external systems. This role involves analyzing requirements, understanding business processes, and developing solutions that support business applications. These solutions often integrate functionality across on-premises systems, external applications, business partner networks, and government sources. The developer will collaborate with cross-functional teams, including IT and business stakeholders, to ensure seamless operations and meet customer needs, managing time and expectations to deliver high-quality solutions that align with business goals and ensure stakeholder satisfaction.

Requirements

Bachelor’s degree in Computer Science or a related field.
Minimum of two (2) years’ experience which must include at least two (2) years’ experience in each of the following: Hands-on experience in Healthcare EDI and FACETS development and analysis
Visual Studio.NET languages (primarily C#), object-oriented programming languages (mainly Python), and SQL/Stored Procedures
Edifecs Encounter Management to manage the end-to-end encounter data submission process
Edifecs Smart Trading Platform for handling EDI transaction flows
Edifecs Spec Builder for EDI data mapping and transformation based on regulatory standards (e.g., HIPAA)
Facets Core Administration platform and TriZetto Facets database structures, particularly in member enrollment, claims processing, billing, and payment management in a healthcare setting
REST/SOAP APIs to support and enhance applications
Working with EDI communication protocols like FTP, SFTP, etc.
Working collaboratively within a cross-functional team, contributing to both technical and business goals required

Responsibilities

Develop, optimize, and support code solutions in languages like Python, C#, and Microsoft Transact-SQL to enhance systems managing healthcare EDI X12 transactions and related business logic.
Design and implement solutions for processing EDI X12 files using Edifecs to parse, transform, validate, and manage EDI data. Ensure that EDI transactions comply with industry specific regulations and company policies regarding data security and privacy (e.g., HIPAA).
Develop and maintain solutions to manage the end-to-end encounter data submission process through the Edifecs Encounter Management, ensuring data accuracy, compliance, and timely delivery to regulatory entities.
Design and develop backend services, APIs, and stored procedures to support reliable data extraction, transformation, and updates on TriZetto Facets database, ensuring data integrity and alignment with healthcare business requirements.
Work with the Facets Core Administration platform to support business logic related to healthcare claims processing, billing, and member data management, ensuring compliance with industry regulations.
Design and implement comprehensive unit, integration, and system testing strategies to ensure the accuracy and functionality of EDI systems. Conduct code reviews and assist entry level developers with technical design decisions and debugging strategies.
Diagnose and resolve complex production issues involving multiple systems or services. Complete post-incident reviews and implement preventive measures.
Identify and implement process improvement within the EDI and Facets environments to increase automation, reduce manual intervention, and improve data accuracy.
Stay current with new healthcare regulations and technologies related to EDI and Facets to propose enhancements and ensure ongoing compliance.