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MMIS Application Track Lead
Are you a Data Analytics/ Informatics subject matter expert with technical/functional Medicaid Data Analytics experience? Are you a MMIS application development expert? Do you want to help us transform the Medicaid market as it embraces modularization, and we help our clients create a new future for Medicaid technology? If you like to design and operate a differentiated customer and provider experience in Medicaid, let us have a conversation.
Work you'll do
Role Summary:
Application domain details:
Technology platforms:
Qualifications
Required:
Preferred:
Are you a Data Analytics/ Informatics subject matter expert with technical/functional Medicaid Data Analytics experience? Are you a MMIS application development expert? Do you want to help us transform the Medicaid market as it embraces modularization, and we help our clients create a new future for Medicaid technology? If you like to design and operate a differentiated customer and provider experience in Medicaid, let us have a conversation.
Work you'll do
Role Summary:
- Works with application development and/or application maintenance in the application domain in a Medicaid, MMIS setting or in a health insurance Managed Care Organization setting.
- Works directly with the Senior Manager leading the DDI or System Operations transition and will have a team of developers and infrastructure personnel to support.
- Will ensure developers are trained and prepare for operational readiness demonstrations.
- Works with the scrum masters and runs agile maintenance and development sprints.
Application domain details:
- Claims and encounters:
- EDI X12 837 claims management for FFS claims
- EDI Clearinghouse
- Encounter data processing from a Medicaid perspective
- Medicaid and CHIP data warehouse and operational data store for claims and encounter sub systems
- Eligibility:
- Medicaid eligibility determination
- Pricing, rate setting, contracts
- Pricing and rate setting application development
- Fee for service price schedule management
- MCO FFS request management
- Long term care and behavioral health
- Long term care (LTC) portal including clinical assessment submission, online authorization
- Behavioral health- contract and payment management, enrollee management, KPI and metrics management
- Portals and outreach
- Member and provider portals including enrollment and eligibility inquiries, requesting ID cards, provider search, FFS pricing requests made by providers
- Authorization submission and data management
- Electronic visit verification management
- EDI X12 270/271 eligibility benefit enquiry
- Reporting and analytics for Medicaid and CHIP claims, enrollment, rates, providers
- Batch and interface operations including FTP, scheduling and error handling within specified SLAs
Technology platforms:
- Assist in planning, architecture, analysis and design of enterprise technology solutions that satisfy business requirements for large complex systems in the Medicaid/MMIS or health insurance claims and pricing space.
Qualifications
Required:
- Associates Degree from accredited college or university
Preferred:
- Agile development experience and SCRUM certification are pluses
- Demonstrated experience in one of the following concentrations related to the application domains:
- 5+ years of custom development experience:
- Windows/.NET/Sqlserver
- Windows/Java/Oracle12x and upward
- 5+ years of Tableau/ Qlik, ArcGIS experience
- 5+ years of EDI EDIFECS XEngine / equivalent experience
- 5+ years of TANDEM/HP Nonstop platform - 5-7 years development experience (GUARDIAN / OSS, COBOL, C, C++, JAVA
- Hands-on TANDEM/NonStop X Systems development; Using Tools and Languages TAL, TACL, Tandem COBOL, TANDEM C++, ENSCRIBE, ENFORM, SQL MP / MX, TANDEM pathway, Tandem internal messaging system, FUP, BATCHCOM, SQLCI, Host security module, tokenization and encryption
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Deloitte LLP