Medicaid Management Information Systems - (MMIS) - Remote- United States - Full Time Role

Role: MMIS (Medicaid Management Information Systems)

Key Responsibilities & Skills

1. System Modernization: Transitioning legacy, monolithic MMIS to modern, modular Medicaid Enterprise Systems (MES).
2. Functional Expertise: Deep knowledge of Medicaid claims, provider enrolment, third-party liability (TPL), pharmacy benefits, and member management.
3. Regulatory Compliance: Ensuring system functionality meets federal and state Medicaid regulations.
4. Project Leadership: Guiding IT teams, developers, and business analysts in system requirements and testing.
5. Data Analysis: Using data to prevent fraud, waste, and abuse, and improving program performance.

1. Experience in designing and building MMIS (Medicaid Management Information Systems) part of Medicaid Enterprise Systems (MES).
2. Involved in System Integration, Data Analytics and Interoperability initiatives and deep understanding of state Medicaid systems.
3. Looking for an MMIS (Medicaid Management Information System) domain expert who is a SME with deep, specialized knowledge of the technology, regulations, and business processes used by state governments to manage Medicaid programs.
4. Should have a deep understanding of and be able to bridge the gap between technical teams and state policy, ensuring compliance with federal (CMS) guidelines and streamlining operations like claims processing, provider enrolment, and eligibility verification.