Job description
MMIS Application Track Manager - Government & Public Sector
Deloitte's Government and Public Services (GPS) practice - our people, ideas, technology and outcomes-is designed for impact. Serving federal, state, & local government clients as well as public higher education institutions, our team of over 15,000+ professionals brings fresh perspective to help clients anticipate disruption, reimagine the possible, and fulfill their mission promise
Are you a Data Analytics/ Informatics subject matter expert with technical/functional Medicaid Data Analytics experience? Are you a MMIS application development expert? Do you want to help us transform the Medicaid market as it embraces modularization, and we help our clients create a new future for Medicaid technology? If you like to design and operate a differentiated customer and provider experience in Medicaid, let us have a conversation.
Work you'll do
Role Summary:
Application domain details:
Technology platforms:
Qualifications
Required:
Preferred:
Deloitte's Government and Public Services (GPS) practice - our people, ideas, technology and outcomes-is designed for impact. Serving federal, state, & local government clients as well as public higher education institutions, our team of over 15,000+ professionals brings fresh perspective to help clients anticipate disruption, reimagine the possible, and fulfill their mission promise
Are you a Data Analytics/ Informatics subject matter expert with technical/functional Medicaid Data Analytics experience? Are you a MMIS application development expert? Do you want to help us transform the Medicaid market as it embraces modularization, and we help our clients create a new future for Medicaid technology? If you like to design and operate a differentiated customer and provider experience in Medicaid, let us have a conversation.
Work you'll do
Role Summary:
- Works with application development and/or application maintenance in the application domain in a Medicaid, MMIS setting or in a health insurance Managed Care Organization setting.
- Works directly with the Senior Manager leading the DDI or System Operations transition and will have a team of developers and infrastructure personnel to support.
- Will ensure developers are trained and prepare for operational readiness demonstrations.
- Works with the scrum masters and runs agile maintenance and development sprints.
Application domain details:
- Claims and encounters:
- EDI X12 837 claims management for FFS claims
- EDI Clearinghouse
- Encounter data processing from a Medicaid perspective
- Medicaid and CHIP data warehouse and operational data store for claims and encounter sub systems
- Eligibility:
- Medicaid eligibility determination
- Pricing, rate setting, contracts
- Pricing and rate setting application development
- Fee for service price schedule management
- MCO FFS request management
- Long term care and behavioral health
- Long term care (LTC) portal including clinical assessment submission, online authorization
- Behavioral health- contract and payment management, enrollee management, KPI and metrics management
- Portals and outreach
- Member and provider portals including enrollment and eligibility inquiries, requesting ID cards, provider search, FFS pricing requests made by providers
- Authorization submission and data management
- Electronic visit verification management
- EDI X12 270/271 eligibility benefit enquiry
- Reporting and analytics for Medicaid and CHIP claims, enrollment, rates, providers
- Batch and interface operations including FTP, scheduling and error handling within specified SLAs
Technology platforms:
- Assist in planning, architecture, analysis and design of enterprise technology solutions that satisfy business requirements for large complex systems in the Medicaid/MMIS or health insurance claims and pricing space.
Qualifications
Required:
- Associates Degree from accredited college or university
Preferred:
- Agile development experience and SCRUM certification are pluses
- Demonstrated experience in one of the following concentrations related to the application domains:
- 5+ years of custom development experience:
- Windows/.NET/Sqlserver
- Windows/Java/Oracle12x and upward
- 5+ years of Tableau/ Qlik, ArcGIS experience
- 5+ years of EDI EDIFECS XEngine / equivalent experience
- 5+ years of TANDEM/HP Nonstop platform - 5-7 years development experience (GUARDIAN / OSS, COBOL, C, C++, JAVA
- Hands-on TANDEM/NonStop X Systems development; Using Tools and Languages TAL, TACL, Tandem COBOL, TANDEM C++, ENSCRIBE, ENFORM, SQL MP / MX, TANDEM pathway, Tandem internal messaging system, FUP, BATCHCOM, SQLCI, Host security module, tokenization and encryption
caravetterealestate.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, caravetterealestate.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, caravetterealestate.com is the ideal place to find your next job.