Job Title: Lead/Project Manager (764064)
Location: Atlanta, GA (Hybrid)
Duration: 12+ Months
*Send me the resumes to venuelika...@thetiltedge.com
<venuelika...@thetiltedge.com>*
*Job Description – *
*Background: *
The State of Georgia is implementing a State-based Exchange (SBE), Georgia
Access, to improve access to affordable, quality health insurance for
residents. The Go-live date for the SBE was November 1, 2024. The SBE is
being implemented as a new division within the Office of Commissioner of
Insurance and Safety Fire (OCI). The goals of Georgia Access are to
increase competition, innovation, and private sector investment in
Georgia’s market, improve the shopping and enrollment experience for
consumers, and reduce the number of uninsured Georgians. Georgia Access is
designed to enhance consumer choice by facilitating a more competitive
marketplace with Georgia’s private-sector partners providing innovative
solutions for enrollment. Consumers will have the option to shop for,
compare, and enroll in qualified health plans (QHPs) and stand-alone dental
plans (SADPs) through certified web-brokers and health insurance carriers
in addition to the State’s consumer portal. Georgia Access will be the
nation’s first SBE that offers both private - and public-sector enrolment
channels for consumers. The State will also certify Navigators and
Certified Application Counselors (CACs) to provide consumer
assistance. Georgia Access is comprised of a number of technology
providers, partners, and interfaces. In the current plan, a contracted
vendor will implement and maintain the Georgia Access Eligibility and
Enrollment System as a Software-as-a-Service (SaaS) product. The
Eligibility and Enrollment System will have several interfaces with federal
and state systems, including the Federal Data Services Hub, the Centers for
Medicare & Medicaid Services (CMS), Internal Revenue Service (IRS), and the
State’s Medicaid eligibility system. In addition, the Eligibility and
Enrollment System interfaces with health insurance carriers for consumer
enrollment information and with private sector partners (e.g., web-brokers)
for plan shopping and selection. Georgia Access must maintain
compliance with HIPAA, PHI, and PII across all vendors and systems.
*Position Description*
The Partner Integration Lead is a member of the SBE’s Technology Department
and reports to the Partner Integration Manager. The Partner Integration
Lead is responsible for analyzing SBE’s EDE (Enhanced Direct Enrollment)
Partners’ policies, and participate in inspections and program
evaluations—that integrate with the Georgia Access Eligibility & Enrollment
System to provide a seamless consumer health insurance shopping experience
from application to enrollment. The Project Manager will build a deep
knowledge of all aspects of the SBE functions and will collaborate closely
with the Bus iness Technical Analyst to identify and meet emerging needs
and improvement opportunities. SBE staff, including the Project Manager,
are expected to develop working knowledge of federal SBE requirements,
reports, policies, systems, and regulations as they apply to the
responsibilities of their role. *Local candidates only as they will be
required to work onsite 3 days per week. *
*Responsibilities: *
This role manages all aspects of the CMS and EDE Partner-related
coordination and activities, including the annual partner Operational
Readiness Reviews (ORRs), change management, system testing, insurance
carrier backend processes, and partner compliance reviews.
The responsibilities of this role include, but are not limited to the
following:
*Program Operations:*
• Support the annual partner application process including
application updates, reviews, and approvals.
• Support the technical implementation of the program for
partners for Open Enrollment (OE) 2026 go-live on November 1, 2026, and
ongoing.
• Support the annual partner ORRs with support from the
Eligibility and Policy Manager and the Information Security Officer.
• Manage the review and approval of partner consumer QHP
applications and technical change requests with support from other SBE
staff as needed.
• Facilitate communication between internal teams, partners, and
CMS, acting as the point of contact for project-related inquiries.
• Maintain detailed records of the partner application process,
ORR status, and CMS change requests.
• Generate regular project status reports and provide updates to
senior management on progress, challenges, and solutions.
• Coordinate reviews and approvals of partner applications,
ensuring all necessary documentation and approvals are in place.
• Work closely with internal teams to manage communications and
feedback during the application process.
• Host regular coordination meetings with cross-functional teams
(e.g., Legal, Policy, Operations) to ensure alignment and address any
concerns during
• the application cycle.
• Monitor CMS changes to their Enhanced Direct Enrollment (EDE)
program and SBE requirements and coordinate with the Eligibility and Policy
• Manager to determine the impact and what changes will be
adopted by Georgia Access.
• Direct the required partner documentation updates (e.g., ORR
materials, business requirements, technical requirements) and review updates
• completed by the Partner Integration Analysts.
• Monitor changes made by CMS to the Enhanced Direct Enrollment
(EDE) program and provide feedback to leadership if the same changes
should be
• adopted by Georgia Access.
• Developing project scopes and objectives, involving all
relevant stakeholders and ensuring technical feasibility
• Creating and maintaining comprehensive project documentation
• Developing detailed project plan(s) and visual tools to track
progress
• Perform risk management to minimize project risks
• Reporting and escalating to management as needed
• Coordinating mitigation of project issues that arise
• Participating in crafting and documenting appropriate
responses to major business issues that arise and could significantly
impact stakeholders
*Stakeholder Engagement:*
• Serve as the main point of contact on behalf of the SBE for
Center of Medicaid and Medicaid Services (CMS) and all EDE partners &
Issuers
• interactions, including program and technical questions,
issues, and coordination with technical vendor(s).
• Skilled in facilitating meetings, discussions, and
brainstorming sessions to drive decisions and outcomes.
• Meet regularly with the partners to communicate program and
policy updates, technical progress, challenges, and mitigation strategies
as necessary.
• Meet with the Technology Director, SBE leadership, and
partners to communicate technical program status, progress, timelines,
challenges, system
• issues, and proposed mitigation strategies as needed.
• Establishing and maintaining relationships with third
parties/vendors and business partners
• Managing relationships with internal clients and all
stakeholders
*Education & Years of Experience:*
• Bachelor’s degree and at least 6 years of relevant professional
experience.
• Master's degree in a relevant field may be substituted for 2 years of
experience.
Experience, Knowledge, & Skills
• Strong background in managing technology implementation projects.
• Proficient in project management software (e.g., Microsoft Project, Jira
etc).
* Preferred Qualifications:*
Certification (or working toward certification): PMP, SSCP, CISSP, CISA,
CISM.
• Experience with CMS integrations and requirements.
• Experience with state health insurance Exchanges, the federal Exchange,
or EDE partners.
• Understanding of the Affordable Care Act (ACA) and the individual market,
including federal and state health insurance policies and programs.
• Experience working with and/or processing 834 enrollment files.
• Experience working in and/or with governmental agencies.
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