Dear Partner,
Good Morning ,
Greetings from Nukasani group Inc !, We have below urgent long term contract project immediately available for Medicaid Subject Matter Expert, Jackson, MS, Onsite need submissions you please review the below role, if you are available, could you please send me updated word resume, and below candidate submission format details, immediately. If you are not available, any referrals would be greatly appreciated.
Interviews are in progress, urgent response is appreciated. Looking forward for your immediate response and working with you.
Candidate Submission Format - needed from you
Full Legal Name
Personal Cell No ( Not google phone number)
Email Id
Skype Id
Interview Availability
Availability to start, if selected
Current Location
Open to Relocate
Work Authorization
Total Relevant Experience
Education./ Year of graduation
University Name, Location
Last 5 digits of SSN
Country of Birth
Contractor Type
DOB: (dd/mm) mm/dd
Home Zip Code
LinkedIn ID
Assigned Job Details
Job Title : Medicaid Subject Matter Expert
Location: Jackson, MS, Onsite
Rate : Best competitive rate
Position Overview
The Client is seeking an experienced Medicaid Subject Matter Expert (SME) to support the implementation and operationalization of a Program Integrity (PI) solution designed to detect, prevent, and investigate fraud, waste, and abuse within the Medicaid program.
The selected consultant will provide deep expertise in Medicaid data domains, program policies, and operational workflows, ensuring that the Program Integrity platform effectively leverages Medicaid data to support investigative analytics and compliance.
This role will work closely with technical teams, program staff, vendors, and project leadership to ensure accurate data interpretation, system configuration, and operational alignment.
Key Responsibilities
Medicaid Data Domain Expertise
Provide expert guidance on the structure, relationships, and operational use of core Medicaid data domains, including:
Member Data
Eligibility and enrollment records
Demographic and coverage information
Managed care enrollment and attribution
Member identifiers and cross-system matching
Provider Data
Provider enrollment and credentialing processes
Provider taxonomy and specialty classifications
Provider affiliations and organizational relationships
National Provider Identifier (NPI) integration and registry management
Claims Data
Professional, institutional, and pharmacy claims
Claim lifecycle and adjudication processes
Service code classifications (CPT, HCPCS, ICD, DRG)
Payment processing and encounter submissions
Claims adjustments, voids, and resubmissions
Managed Care Data
Managed Care Organization (MCO) encounter data
Capitation payment structures
Managed care reporting requirements
Encounter-to-claim mapping and validation
Program Integrity Support
Provide guidance on data requirements for fraud, waste, and abuse detection
Assist with data mapping and data model validation for the Program Integrity platform
Support development of analytics models, investigative rules, and workflows
Identify data quality issues and recommend remediation strategies
Help define investigative use cases and operational scenarios
Ensure accurate interpretation of Medicaid policies and program rules within the system
Implementation Support
Collaborate with system integrators, technical teams, and vendors
Support data ingestion, transformation, and validation processes
Participate in requirements gathering and system design sessions
Provide business context and domain knowledge to technical teams
Review system outputs for accuracy and operational relevance
Support User Acceptance Testing (UAT) and validation activities
Stakeholder Collaboration
The Medicaid SME will work closely with:
Program Integrity leadership
Medicaid program staff
Data analytics teams
IT and data architecture teams
System implementation vendors
Managed Care oversight teams
Expected Deliverables
Validation of Medicaid data domain documentation
Data mapping and data dictionary validation
Program Integrity use case and business rule validation
Data quality assessments and improvement recommendations
System configuration and validation documentation
UAT participation and feedback
Implementation support reports and findings
Minimum Qualifications
Candidates must meet all minimum requirements to be considered.
15+ years of experience working with Medicaid program data and operations
Demonstrated expertise in the following Medicaid data domains:
Member / Eligibility data
Provider enrollment data
Claims and encounter data
Managed care program data
Experience working with Gainwell MMIS or similar Medicaid Management Information Systems
Strong understanding of Medicaid policies, regulations, and program operations
Experience supporting large system implementations or modernization initiatives
Ability to communicate complex Medicaid data concepts to both technical and non-technical stakeholders
Preferred Qualifications
The following experience is preferred but not required:
Experience implementing or managing Provider Enrollment systems
Experience implementing or managing claims processing systems
Familiarity with CMS reporting requirements and regulatory compliance
Best,
Bhavani
Recruiter | IT & Digital Marketing
P:
540 W Galena Blvd, Suite 200
Aurora, IL 60506
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