Solution Architect (Medicaid Exp)

Job Title: Solution Architect

Role Overview
The Solution Architect is responsible for designing, implementing, and optimizing enterprise-level solutions for Medicaid Management Information Systems. This role ensures alignment of technology architecture with Medicaid business processes, federal/state regulations, and industry standards, enabling scalable, secure, and compliant healthcare solutions.

Job Location & Mode: United States, Remote

Key Responsibilities
1.    Solution Architecture & Design
•    Design end-to-end MMIS solutions, including eligibility, claims processing, provider management, and payment modules.
•    Define system architecture across application, data, and integration layers.
•    Develop scalable, modular, and interoperable system designs aligned with MITA (Medicaid Information Technology Architecture) framework.
•    Ensure solutions align with CMS guidelines and state Medicaid regulations.
2.    Technical Leadership
•    Provide architectural guidance to development, integration, and QA teams.
•    Review and approve technical designs, code, and configurations.
•    Lead architecture governance and design reviews.
•    Mentor technical teams on best practices and emerging technologies.
3.    Integration & Interoperability
•    Design integrations with:
o    Federal and State systems (CMS, HHS)
o    Third-party vendors (EDI, clearinghouses)
o    Healthcare systems (EHR/EMR)
•    Ensure adherence to interoperability standards such as:
o    HL7 / FHIR
o    X12 (EDI transactions)
o    APIs and microservices architecture
4.    Data & Analytics
•    Define data architecture including data flows, storage, and governance.
•    Ensure support for reporting, analytics, and regulatory compliance.
•    Oversee data migration and modernization initiatives.
5.    Compliance & Security
•    Ensure solutions comply with:
o    HIPAA
o    CMS Medicaid guidelines
o    State-specific requirements
•    Implement robust security, privacy, and audit controls.
6.    Modernization & Transformation
•    Lead MMIS modernization initiatives (legacy transformation to cloud/microservices).
•    Evaluate and adopt emerging technologies (AI/automation, cloud-native design).
•    Support modular MMIS initiatives.

Required Qualifications Education
•    Bachelor’s or Master’s degree in Computer Science, Information Systems, or related field
Experience
•    10+ years of IT experience with at least:
o    5+ years in solution architecture
o    5+ years in healthcare or Medicaid systems
•    Proven experience working on MMIS or large healthcare payer systems

Technical Skills
•    Strong experience in:
o    Enterprise architecture frameworks (TOGAF preferred)
o    Cloud platforms (Azure/AWS/Google Cloud Platform)
o    Microservices and API design
o    Integration technologies (ESB, REST/SOAP)
•    Knowledge of:
o    Medicaid domains (Claims, Eligibility, TPL, Provider Mgmt)
o    EDI X12 transactions (837, 834, 835, etc.)
o    HL7/FHIR
Domain Knowledge
•    Deep understanding of:
o    Medicaid business processes
o    CMS regulations and MITA framework
o    Healthcare compliance standards
Preferred Skills
•    Experience with MMIS modernization projects
•    Knowledge of COTS Medicaid platforms (e.g., Conduent, Gainwell, Cognizant solutions)
•    Certification in:
o    TOGAF / Cloud Architect (Azure/AWS)
o    Healthcare IT standards
Key Competencies
•    Strategic thinking and problem-solving
•    Strong communication and stakeholder management
•    Leadership and mentoring
 
•    Ability to work in complex, regulated environments

Success Metrics
•    Successful delivery of MMIS architecture solutions
•    Compliance adherence (zero audit issues)
•    System scalability, uptime, and performance
•    Stakeholder satisfaction