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
Never miss an opportunity! Create an alert based on the job you applied for.