Provider Data Management (PDM) With TriZetto Facets Experience

10+ years of experience with the TriZetto Facets Provider Module

Deep understanding of healthcare payer provider operations and provider lifecycle management.

Strong understanding of provider contracting and provider setup requirements across Medicaid, Medicare, Exchange (Marketplace) and Commercial Health Plans

Ability to analyze differences in provider configuration, contracting, reimbursement methodologies, network participation, specialties, and affiliations across multiple lines of business.

Strong experience analyzing provider data quality issues, provider record discrepancies, and duplicate provider management strategies.

Hands-on experience working with external provider data sources, including:

NPPES

CMS Provider Files

State Medicaid Provider Files

Credentialing Data Sources

Provider Directory Data Sources

Strong understanding of Facets Provider integration capabilities, including:

XPF Batch Processing

Provider Web Services

Provider Data Synchronization Mechanisms

Inbound and Outbound Provider Integrations

Real-time and Batch-Based Integration Patterns

Proven experience implementing provider data integrations using standard Facets product capabilities and industry best practices.

Strong knowledge of Facets Extension capabilities related to the Provider Module, including provider maintenance workflows, validation frameworks, custom provider processing, and provider batch extensions.

Ability to evaluate and recommend appropriate integration approaches using XPF batches and Web services

Strong Microsoft SQL Server development experience including:

Complex SQL Queries

Stored Procedures

Data Reconciliation

Data Profiling

Performance Optimization

Experience with enterprise integration architectures and service-oriented design.

Excellent analytical, problem-solving, and communication skills.

Preferred Qualifications

Experience implementing Provider Data Management solutions.

Experience establishing provider data governance frameworks and operating models.

Hands-on experience developing or supporting Facets Provider Extensions.

Experience modernizing legacy provider integrations by transitioning batch-based processes to API-driven and event-driven architectures.

Experience with Kafka, SSIS, Azure DevOps, Git, and CI/CD Pipelines

Strong understanding of healthcare interoperability standards.

Experience mapping and transforming TriZetto Facets Provider data structures to HL7 FHIR resources

Understanding of provider directory modernization and interoperability initiatives.

Experience leveraging AI-assisted development tools such as GitHub Copilot, Claude Code, or similar platforms.

Previous experience supporting large enterprise healthcare organizations is highly desirable.

Leadership Expectations

Depending on experience, this individual may:

Lead provider data architecture and solution design initiatives.

Establish provider data governance standards and best practices.

Drive enterprise data quality and deduplication strategies.

Mentor developers, analysts, and architects.

Partner with enterprise architecture teams on modernization initiatives.

Influence long-term provider data management strategy and roadmap development.

What We're Looking For

We are looking for someone who combines deep Facets Provider Module expertise with strong healthcare provider domain knowledge and architectural leadership. The ideal candidate understands not only how provider data is configured in Facets, but also how provider contracting, network participation, credentialing, provider hierarchies, affiliations, and line-of-business differences impact provider data management.