Medicaid Business Subject Matter Expert

Position: Medicaid SME with experience as Test Lead

Preferred current location: Richmond, VA

Hybrid: 3 days work from office

Note: Applicants must apply via this posting on Dice. Seperate emails will not be reviewed.

Job Summary:

We are looking for a Medicaid Business Subject Matter Expert (SME) with strong hands-on experience as a Testing Manager. The ideal candidate will have deep expertise in Medicaid systems and business processes, with proven experience in leading and managing large-scale testing activities. Strong documentation and communication skills are also required.

Key Responsibilities:

• Analyze and document Medicaid business processes (provider enrollment, eligibility, claims, prior authorization, encounters, reporting).
• Interpret and apply CMS regulations, Medicaid state plan requirements, and federal guidance to ensure system compliance and operational accuracy.
• Collaborate with development, data, and project teams to design, validate, and test system components and workflows.
• Lead end-to-end testing activities, including test planning, test case development, test execution, defect management, and reporting for both manual and automated testing efforts.
• Develop and maintain detailed documentation, including:
  • Trading Partner Testing Plans
  • System Integration Plans
  • Quality Management Plans
  • Performance Testing Plans
  • Companion Guides
  • Test Summary Reports and Results
• Conduct and facilitate requirements and testing sessions with stakeholders across policy,
  operations, compliance, and IT teams.
• Coordinate and support User Acceptance Testing (UAT) to ensure successful validation of Medicaid system functionality across releases.
• Leverage data analysis to validate business rules, identify anomalies, and support decision-making.
• Provide regular testing reports, issue summaries, and risk assessments to project leadership.
• Perform other related duties as assigned.

Required Qualifications:

• 10+ years of IT systems analysis, with a focus on healthcare systems and Medicaid processes.
• Subject matter expertise in Medicaid business processes, systems, and regulations.
• Experience as a Testing Manager overseeing large-scale testing efforts.
• Strong documentation and communication skills.

Required Education:

• Bachelor’s degree in business administration or science or a related field.

Required Experience:

• Over 10 years of experience in IT systems analysis, with a strong emphasis on healthcare systems and Medicaid processes.

Required Skills:

• SME in Medicaid
• In-depth knowledge of Medicaid business processes, regulations, and systems.
• Proficient in business process analysis, requirements gathering, and creating detailed
  documentation.
• Good problem-solving, analytical, and communication skills.

Preferred:

• Background working with government contractors is highly desirable.