Medicaid Systems Operations Manager MMIS & Claims

Job Title: IT Healthcare Project Manager Medicaid MMIS Operations

Overview / Summary
HTC is seeking an IT Healthcare Project Manager to lead MMIS Medicaid Systems Operational Management. This role oversees business-critical operations supporting MCO enrollment, claims and encounter processing, payment functions, and related support systems. The environment is fast-paced and requires participation in after-hours support for system releases and unplanned incidents.

Key Responsibilities

• Lead MMIS systems operational management, including replacement systems as they are implemented.
• Oversee, coordinate, and perform operational support activities for MMIS, Encounter Processing System, and supporting systems.
• Coordinate with vendors, the Office of Cyber Security, Enterprise Architecture, and other stakeholders.
• Lead teams providing production support, helpdesk services, interface/EDI support, and stakeholder monitoring.
• Oversee incident and issue management, including documentation, tracking, escalation, and resolution of production issues.
• Identify and mitigate operational issues while ensuring decisions and actions are properly documented.
• Manage internal and external escalations and ensure timely, effective resolution.
• Ensure work is assigned appropriately and operational issues are resolved efficiently.
• Ensure compliance with security requirements (CMS, SSA, etc.) and monitor findings and recommendations through completion.
• Work with the contract monitor to establish and monitor service level agreements (SLAs).
• Respond promptly to inquiries.
• Promote workforce engagement and maintain a safe, professional, and productive work environment.
• Implement, monitor, and enforce Standard Operating Procedures (SOPs), and communicate when practices differ from established procedures.
• Oversee release management activities, including stakeholder communication, pre-implementation planning, readiness checks, and post-implementation monitoring.
• Support change management by coordinating backlog grooming and maintenance and ensuring compliance with required approval processes.
• Provide after-hours and on-call support for incidents and system releases as needed.

Required Qualifications

• Bachelor's degree in a technical, business, or healthcare field, or 5+ years of equivalent experience in business/systems analysis and/or computer systems development/modification.
• 5+ years of experience managing system operations and/or administrative program functions for claims and/or encounter processing in a healthcare environment.
• 5+ years of project management experience managing system implementations or enhancements.
• 3+ years of experience managing external vendors providing system development.
• Ability to provide incident management on-call and after hours.
• Excellent communication skills with staff ranging from frontline personnel to executive management.
• Ability to manage work and provide guidance.
• Experience assigning and overseeing team workload.
• Knowledge of the system development lifecycle.
• Strong documentation and process management skills.

Preferred Qualifications

• Prior experience managing operations of Medicaid Enterprise systems.
• Knowledge of Medicaid eligibility, enrollment, and MMIS domain concepts.
• Experience with ticketing software.
• Experience writing Standard Operating Procedures for new system implementations.
• Ability to make presentations and prepare reports.
• AWS Cloud Certifications.

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