IN3945-1 - Business Analyst/SME with heavy healthcare experience including financial management, Provider management, Managed Care, Pharmacy/drug rebate, Behavioral health, Long term care, Prior authorization, Policy/ benefit plan administration, Ele

Location: Columbia SC

Positions: 6

Duration: 12 months

 

SCOPE OF THE PROJECT:

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.

 

DAILY DUTIES / 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.

 

SCDHHS 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 (RANK IN ORDER OF IMPORTANCE):

 

•             Strong background and at least six years experience in healthcare

insurance business operations (payer or provider side; government or commercial side). Experience in multiple business areas is a plus.

Note: IT operations are not the same as business operations.

•             At least three years experience in healthcare insurance IT software/

systems implementations performing duties described in the “Daily Duties/Responsibilities” section above.

•             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 (RANK 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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