Job code: IN4128-1
Medicaid SME/Business Analyst with healthcare insurance operations & development, MITA, MMIS, and MECT experience
Location: Columbia, SC (In-person interview)
Duration: 12 months
Positons: 2
SCDHHS is seeking a SME with the business expertise and operations experience, information technology project experience, and interpersonal skills necessary to enable success on this high- visibility project.
REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
• Strong background with at least ten years experience in Medicaid Eligibility operations. Experience in multiple states is a plus. Note:
IT operations are not the same as business operations.
• Experience working for a state Medicaid agency, a Medicaid fiscal agent vendor (in member enrollment), or CMS. Experience with more than one of these organizations is a big plus.
• At least three years experience in healthcare insurance IT software/ systems implementations and operations.
• Ability to properly document business requirements.
• Ability to interpret business process and business data models.
• Superb written and oral communications skills, including the ability to give presentations to executive management.
PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
• Understanding of modern software development techniques, approaches and technologies.
• Experience working both for the State and vendor(s) as well as other social service agencies.
• Understanding of the Medicaid Information Technology Architecture (MITA).
• Understanding of broader perspective on Medicaid operations including MMIS (particularly recipient subsystem).
• Understanding of the Medicaid Enterprise Certification Toolkit
(MECT) including experience in certification from the state or CMS side.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.
REQUIRED EDUCATION:
Bachelor’s degree in a related field.
Master’s degree is desirable.
Scope:
The Medicaid replacement projects (including Eligibility/ Member
Management) are among the most complex IT projects taken on by the State’s Department of Health and Human Services in partnership with Clemson University. These projects are multi-year efforts to replace the State’s aging Medicaid systems with a multi-tier application environment that requires modern technologies, technical practices and substantial collaboration with a variety of stakeholders. The software development and implementation for the replacement Eligibility and Member Management system will be led by Clemson University. This position will collaborate across the State’s business owners/users, the project management team and the Clemson team.
DAILY DUTIES / RESPONSIBILITIES:
A Replacement Eligibility and Member Management 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 led and completed by Clemson University. 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 Eligibility and Member Management system.
• Planning for, conducting, and reporting on testing and other quality assurance activities.
• Other related activities.
Submit Subject Matter Experience Matrix:
Note: include only healthcare insurance operations/development positions related to this posting. Add extra lines, if necessary.
Start/End Dates Position Title Employer (and client, if applicable) Subject Matter Area(s) (e.g., provider, claims, TPL, etc.) (Select
One) Business Operations or System Development or Both
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