MMIS Technical Team - Lead
The team
Deloitte’s Government and Public Services (GPS) practice – our people, ideas, technology and outcomes—is designed for impact. Serving federal, state, & local government clients as well as public higher education institutions, our team of over 15,000+ professionals brings fresh perspective to help clients anticipate disruption, reimagine the possible, and fulfill their mission promise.
Deloitte’s Health Technology offering transforms the way the Healthcare IT market embraces modernization and modularization. Using our deep health, government, and technology consulting experience, our team strategically advises on design as well as implements and deploys solutions. In order to help clients reduce costs, improve health outcomes, and respond to public health crises, our Health Technology practice addresses critical health agency issues including: claims management, electronic health records, health information exchanges, health analytics, and health case management.
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.
- 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
Required Qualifications:
- 15+ years of Health Claims experience
- State Medicaid system experience
- PEMS and C21 experience
- Experience with UAT and file mapping
- Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future
Desired Qualifications:
- Understanding of functional design process
- SQL experience
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