Overview
Remote
Depends on Experience
Full Time
Skills
FIDE
CMS
Medicaid/Medicare
healthcare
Architect
Job Details
Job Description
Must Have Technical/Functional Skills
Lead the architecture and integration of FIDE plan systems, including claims processing, eligibility, provider management, and reporting platforms.
Comprehend end-to-end workflows for dual-eligible member journeys, ensuring compliance with CMS and state requirements.
Oversee system enhancements for rate updates, retroactive claims, and encounter data submissions.
Collaborate with cross-functional teams to identify pain points and recommend process and technology improvements.
Ensure auditability, data integrity, and regulatory compliance across all FIDE-related systems.
Develop and maintain architecture documentation, data flow diagrams, and integration specifications.
Support implementation of new markets and retrofit best practices into existing FIDE programs.
Roles & Responsibilities
Lead the architecture and integration of FIDE plan systems, including claims processing, eligibility, provider management, and reporting platforms.
Comprehend end-to-end workflows for dual-eligible member journeys, ensuring compliance with CMS and state requirements.
Oversee system enhancements for rate updates, retroactive claims, and encounter data submissions.
Collaborate with cross-functional teams to identify pain points and recommend process and technology improvements.
Ensure auditability, data integrity, and regulatory compliance across all FIDE-related systems.
Develop and maintain architecture documentation, data flow diagrams, and integration specifications.
Support implementation of new markets and retrofit best practices into existing FIDE programs.
Qualifications:
Bachelor s degree in Computer Science, Information Systems, or related field (Master s preferred).
8+ years of experience in healthcare IT, with at least 1 year in Medicaid/Medicare duals or FIDE programs.
Strong knowledge of claims, eligibility, provider, and compliance systems.
Experience with system integration, data management, and regulatory reporting.
Generic Managerial Skills, If any
Collaborate with Project stakeholders and Drive the team to complete the deliverables
Proven success working in large Medicare FDE programs
Expertise in solving complex business functional issues, and manage the stakeholders.
Team management
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