Summary :

We are seeking a highly skilled EDIFECS/FACETS/EDI Specialist to support our healthcare integration, claims processing, and data exchange platforms.

The candidate should have strong experience working with EDI transactions, FACETS core administration platform, and EDIFECS tools for mapping, validation, and processing healthcare data.

EDI & EDIFECS :

- Design, configure, and maintain EDIFECS transaction processing flows (TPF), maps, and rules

- Handle HIPAA EDI X12 transactions: 834 (Enrollment), 837 (Claims), 835 (Remittance), 270/271 (Eligibility), 276/277 (Claim status)

- Conduct testing and validation of inbound and outbound EDI transactions

- Troubleshoot and resolve issues in EDIFECS XEngine, SpecBuilder, and Route Manager

- Coordinate with trading partners for connectivity setup and EDI testing

FACETS Platform :

- Support integration of EDI processes with FACETS core system (TriZetto)

- Work with modules such as Enrollment, Claims, Billing, and Provider

- Develop and maintain batch jobs, extracts, and interface points between FACETS and external systems

- Perform data reconciliation and exception handling within FACETS workflows

General Integration & Support :

- Work closely with business teams to gather and translate integration requirements

- Monitor EDI file transmissions and resolve production issues

- Document workflows, mappings, and configurations

- Collaborate with QA teams for end-to-end system testing

- Participate in implementation and support of new trading partners or internal business units

Skill Area :

Requirement :

- EDIFECS Tools : Strong hands-on with EDIFECS SpecBuilder, XEngine, TPF, and Route Manager

- EDI Standards : In-depth knowledge of HIPAA 4010/5010 EDI formats (834, 837, 835, etc.)

- FACETS : 3-5 years working with FACETS core system modules and data structures

- Healthcare Domain : Familiarity with payer workflows, claims lifecycle, and member/provider data

- Scripting / SQL : Intermediate SQL skills for data analysis and reconciliation

- File Formats : Flat files, XML, JSON, X12

- Soft Skills : Strong communication, documentation, and problem-solving skills

Good to have :

- Experience with ETL tools or middleware (e.g., Mirth, MuleSoft, Boomi)

- Familiarity with Medicare/Medicaid processing rules

- Exposure to Agile or Scrum methodologies

- Prior experience with FACETS API or Web Services