MMIS Application Track Lead

Management Consulting | Core Business Operations

Jersey City, New Jersey, United States

Position Summary

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.





  • Associates Degree from accredited college or university



  • 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
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Requisition code: 146893


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