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Department of Health and Human Services
Remote work Availability: 25%
SCOPE OF THE PROJECT:
The Replacement Medicaid Management Information System (MMIS) project is one of the largest IT projects for the State of South Carolina. It is a multi-year effort to replace the State's aging MMIS, eligibility system, and related applications with a modern, service oriented architecture based system. This project will be very complex and will demand exceptionally high quality team members.
DAILY DUTIES / RESPONSIBILITIES:
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.
Requirements development execution, including the elicitation, analysis, specification and validation.
Documenting and analyzing agency business processes and recommending improvements.
Documenting and analyzing data requirements and relationships.
Participate in the requirements management processes, including change control; version control; tracking and status reporting; and traceability.
Providing requirement interpretation and guidance to technical and test teams.
Proactively identifying risks, issues, and action items leading to possible solutions.
Interacting with internal and external organizations (i.e. vendors, State and Federal government agencies, State providers and beneficiaries, and other stakeholders).
Planning for, conducting, and reporting on testing and other quality assurance activities.
Other related activities.
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.
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.
REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
General Medicaid or Medicare Experience Required.
Strong background and at least six years experience in healthcare insurance business operations (payer or provider side with an emphasis on provider eligibility, enrollment and management; government or commercial side). Experience in multiple business areas is a plus. Note: IT operations are not the same as business operations.
At least four years experience in healthcare insurance IT software/systems implementations performing duties described in the "Daily Duties/Responsibilities section above.
Ability to properly document business requirements.
Ability to interpret business process and business data models.
Vendor management experience.
Superb written and oral communications skills, including the ability to give presentations to executive management. Strong proficiency in English is required.
Strong team player and collaborator, including the ability to contribute to and leverage process improvements.
Impeccable integrity. This project will have very high visibility and will impact significant expenditures of public funds. Candidates must be confident with their abilities to make correct decisions and the courage to speak out when necessary.
Willingness and ability to effectively engage with people and organizations on a continuous basis.
PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
Understanding of the Medicaid 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 requirements documents as well as business process and business data models.
Public sector procurement experience is a plus.
Experience with AGILE development environment
Bachelor's degree or 7 or more years equivalent experience.
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