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Phone Hire Location: Columbia, SC Duration: 12+ months Rate: Open Description A Replacement MMIS Subject Matter Expert (SME) is responsible for evaluating agency needs, as-is and to-be business processes, and technical designs to provide analysis and advice on strategies for information technology solutions and non-technical solutions. The majority of the system development work will be outsourced to vendors and other State organizations. Subject matter areas include: provider management, member (beneficiary) management/eligibility, claims (professional, institutional, pharmacy, dental, durable medical equipment, transportation, etc.), third party liability, financial management, reimbursement methodology, drug rebate, prior authorization, managed care, behavioral health, long-term care, program integrity, electronic health records, benefit plan administration, etc. Skills Needed * Familiarity with ICD-9/ICD-10 coding standards, X12 EDI transactions, and the Affordable Care Act and it impacts on Medicaid eligibility and health insurance exchanges is also beneficial. . Analytics Background required . Strong background and at least six years experience in healthcare insurance business operations (payer or provider side; government or commercial side). Note: IT operations are not the same as business operations. . At least four years experience in healthcare insurance IT software/systems implementations. . Ability to properly document business requirements. . Ability to interpret business process and business data models. . Vendor management experience. . Willingness and ability to effectively engage with people and organizations on a continuous basis. . Information Technology Architecture (MITA). . Understanding of the Medicaid Enterprise Certification Toolkit (MECT). . Experience in an outsourced healthcare insurance operations environment. . Experience on an outsourced IT development project. . Experience in creating business process and business data models. . Public sector procurement experience is a plus. Thanks, Dinesh Kumar Software People Inc. <blocked::http://www.softwarepeople.us/> www.softwarepeople.us <mailto:[email protected]> [email protected], Ph: 631- 739-8499 Fax: 631-574-3122 Certifications: SBA 8a/SDB, NJ MWBE, NY MWBE, VA SWaM, DE OMWBE, MA MWBE -- You received this message because you are subscribed to the Google Groups "Exact Match" group. To unsubscribe from this group and stop receiving emails from it, send an email to [email protected]. To post to this group, send email to [email protected]. Visit this group at http://groups.google.com/group/exact-match?hl=en. For more options, visit https://groups.google.com/groups/opt_out.
