analysis, change management, version control, reporting, claims,
business process, MITA, MECT, procurement and insurance experience
Project:
This is a large project with a "startup" attitude. A majority of the
team is made up of experienced POconsultants, and we are seeking
individuals who are highly productive, very flexible, and can work in
an environment where ambiguity is common. Each team member is expected
to contribute with minimal supervision. The project is taking a
different approach than most, and we are seeking individuals who are
strong collaborators, who want to make a positive contribution to the
State of South Carolina, and who do not need a perfect roadmap ahead
of them. The project will use modern technologies and modern
strategies, and the team cultivates "thought leadership." Candidates
who enjoy working on complex, change-oriented projects with motivated
team members will find this position attractive.
The Replacement Medicaid Management Information System (MMIS) project
is one of the largest IT projects for the State of South Carolina. It
is a multi-year effort to replace the State''s aging MMIS, eligibility
system, and related applications with a modern, service oriented
architecture based system. This project will be very complex and will
demand exceptionally high quality team members.
RESPONSIBILITIES:
A Replacement MMIS Subject Matter Expert (SME) is responsible for
evaluating agency needs, as-is and to-be business processes, and
technical designs to provide analysis and advice on strategies for
information technology solutions and non-technical solutions. The
majority of the system development work will be outsourced to vendors
and other State organizations.
Duties include:
.. Requirements development execution, including the elicitation,
analysis, specification and validation.
.. Documenting and analyzing agency business processes and recommending
improvements.
.. Documenting and analyzing data requirements and relationships.
.. Participate in the requirements management processes, including
change control; version control; tracking and status reporting; and
traceability.
.. Providing requirement interpretation and guidance to technical and
test teams.
.. Proactively identifying risks, issues, and action items leading to
possible solutions.
.. Interacting with internal and external organizations (i.e. vendors,
State and Federal government agencies, State providers and
beneficiaries, and other stakeholders).
.. Participating in standup of business operations supporting the
Replacement MMIS.
.. Planning for, conducting, and reporting on testing and other quality
assurance activities.
.. Other related activities.
The Client is seeking multiple SMEs covering the breadth of functions
within the State''s Medicaid agency with the business expertise and
operations experience, information technology project experience, and
interpersonal skills necessary to enable success on this high-
visibility project. Subject matter areas include provider management,
member (beneficiary) management/eligibility, claims (professional,
institutional, pharmacy, dental, durable medical equipment,
transportation, etc.), third party liability, financial management,
reimbursement methodology, drug rebate, prior authorization, managed
care, behavioral health, long-term care, program integrity, electronic
health records, benefit plan administration, etc.
REQUIRED SKILLS (IN ORDER OF IMPORTANCE):
.. Strong background and at least three years experience in healthcare
insurance operations (payer or provider side; government or commercial
side). Experience in multiple business areas is a plus.
.. At least three years experience in healthcare insurance IT software/
systems implementations performing duties described in the "Daily
Duties/Responsibilities" section above. Three additional years in
implementation projects can substitute for three years of operations
experience.
.. Ability to properly document business requirements.
.. Ability to interpret business process and business data models.
.. Vendor management experience.
.. Superb written and oral communications skills, including the ability
to give presentations to executive management. Strong proficiency in
English is required.
.. Impeccable integrity. This project will have very high visibility
and will impact significant expenditures of public funds. Candidates
must be confident with their abilities to make correct decisions and
the courage to speak out when necessary.
.. Willingness and ability to effectively engage with people and
organizations on a continuous basis.
PREFERRED SKILLS (IN ORDER OF IMPORTANCE):
.. Understanding of the Medicaid Information Technology Architecture
(MITA).
.. Understanding of the Medicaid Enterprise Certification Toolkit
(MECT).
.. Experience in an outsourced healthcare insurance operations
environment.
.. Experience on an outsourced IT development project.
.. Experience in creating business process and business data models.
.. Public sector procurement experience is a plus.
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