Deloitte US

MMIS Application Track Lead

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