Medicaid SME (Subject Matter Expert)

Moss Point, MS, US • Posted 1 day ago • Updated 1 day ago

Contract W2

Contract Independent

Contract Corp To Corp

No Travel Required

On-site

$60 - $70/hr

Fitment

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Job Details

Skills

Leadership
MMIS
Acceptance Testing

Summary

Role: Developer - Medicaid SME

Location: Jackson, MS

Work Mode: Onsite

Employment Type: Contract

Interview Mode: Only Video

We are seeking an experienced Medicaid SME with deep expertise in Medicaid program data, policies, and operational workflows to support the successful implementation and operationalization of a Program Integrity (PI) solution. The ideal candidate will work closely with technical teams, program leadership, and implementation partners to ensure the system effectively leverages Medicaid data to detect and prevent fraud, waste, and abuse (FWA).

Key Responsibilities:

Provide subject matter expertise on Medicaid data domains, including Member Eligibility, Provider Enrollment, Claims, and Managed Care data.
Support data mapping, data modeling, and validation activities to ensure accurate integration of Medicaid data within the Program Integrity tool.
Collaborate with technical teams, data analysts, and system vendors to assist with data ingestion, transformation, and system configuration.
Participate in requirements gathering, solution design discussions, and system implementation activities.
Assist with data validation, reconciliation, and User Acceptance Testing (UAT) to ensure system outputs align with Medicaid program rules.
Identify data quality issues, gaps, and inconsistencies, and provide recommendations for remediation.
Ensure proper interpretation of Medicaid policies, compliance standards, and regulatory requirements within the system.
Work closely with Program Integrity teams and stakeholders to define investigative use cases and support fraud detection workflows.

Requirements:

15+ years of experience working with Medicaid programs, data, and operations.
Strong expertise in Medicaid data domains (Member, Provider, Claims, Managed Care).
Experience working with MMIS platforms (Gainwell preferred).
Experience supporting large-scale Medicaid system implementations or modernization initiatives.
Ability to communicate complex Medicaid data concepts to both technical and non-technical stakeholders.

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 10460158
Position Id: 8905647
Posted 1 day ago

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