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Subject Matter Expert for Healthcare  
Ref No.: 17-00326
Location: Cedar Rapids, Iowa
Position Type:Contract
Start Date: 05/18/2017

Tailwind Associates, an EOE, has a 12 + months contract opportunity with our client in El Paso, Texas for a Subject Matter Expert for Healthcare

Job Description:

Candidate will have the responsibility of Interacting with the State Business Users, external users and Client to gather business requirements and translate them in the form of business requirements for the application. Others include Documenting requirements gaps and process artifacts including project objective, business requirements, functional system requirements, Non-functional system requirements, data requirements, constraints, assumptions and current state process analysis and future state process maps.
At times, candidate will also need provide thought leadership to the client for their business and interact with industry teams.

Responsibilities/Requirements:

  • 15+ years of experience as a Subject Matter Expert with exposure in analyzing and providing solutions to various business and customer needs for a Healthcare Domain.
  • 15 years of experience in Medicaid pharmacy domain
  • Develop business and system requirements subject areas and reports for the Medicaid System.
  • Manage and analyze Medicaid modules and also to support reporting and analytical queries from business users.
  • Conduct the Sessions to Dev team and QA team to get the complete understanding of the system.
  • Review the test case scenarios for System Integration, Functional Integration.
  • Need to participate in end user training of the system
  • Need to participate in federal certification for health care system


Required Skills:
  • Extensive and explicit knowledge in Pharmacy/HIE/SLR functions.
  • Prior experience in MMIS projects and platforms
  • Very good knowledge and detailed understanding of US healthcare domain
  • Complete understanding of the different integration points of Healthcare transactions
  • End to End knowledge on Medicaid modules like Claims Adjudication, Claims Pricing, Claims Payment, TPL, Member Management, Financial process, Service Authorization and Provider / Payer responsibilities
  • In depth knowledge on the MITA Business Processes
  • Detailed understanding on Pharmacy medical claims. Ability to analyze and assist with the claims processing and adjudication methods.
  • Experience on Various EDI Healthcare transactions
  • Experience in designing new systems by analysing requirements, studying legacy product, constructing workflow charts/diagrams, studying system capabilities, writing detailed specifications
  • Excellent verbal communication skills for the required Interaction with Customer, demonstrate the systems in front of the senior executives as needed and to conduct end user trainings
  • Excellent interpersonal skills to interact with customer and convince on the solutions/approaches as needed
  • Experience on ICD 9 to 10 conversions and GEMS Techniques
  • Excellent written communication skills for detailing the Business requirements, use case documentation, etc.,
  • Experience to work with Development and QA team to ensure that there is a common understanding of the specification and bridge the gap if any
  • Experience in Review the System Design document and database document to ensure that Functional Design document is properly mapped and traced to the requirements
  • Experience in write and maintaining user documentations
  • Experience to provide help desk support




All qualified applicants will receive consideration for employment without regard to race, creed, color, religion, national origin, sexual orientation, gender identity, disability, sex or age.