Medicaid Mmis Jobs (NOW HIRING)

ProSidian Consulting is looking for professionals who share our commitment to integrity, quality, and value. ProSidian is a management and operations consulting firm with a reputation for its strong national practice spanning six Enterprise Solution Areas including Risk Management, Energy & Sustainability, Compliance, Business Process, IT Effectiveness, and Talent Management. We help clients improve their operations.

ProSidian seeks an IT MMIS Systems Integration Quality Manager (QM) to support requirements for a State Government Medicaid Management Information System (MMIS).

Functional Responsibility: Responsible for managing the product backlog in order to achieve the desired outcome that a product development team seeks to accomplish. They are there to ensure that the business need is being met and that any disconnects get clarified via collaboration with the South Carolina Department Of Health And Human Services (SCDHHS) Principal Product Owner (or designee). The IT MMS Quality Manager (QM) will collaborate with the IT MMS Product Owner (PO) to lead story breakdown sessions with the team and help organize the work, either on the wall or within an Agile management tool (e.g., Jira). The PO should develop and possess Medicaid and/or MMIS Systems Integration knowledge. We expect our Project and Department Managers to be highly responsive to SCDHHS's requests; however, if at any point the government would like to escalate a matter to ProSidian's senior leaders.

Project Background: The client is a Stake Level Department of Health and Human Services (Sponsor: Bureau of Information Systems) which is transitioning to a new Medicaid Management Information System (MMIS). The State Dept of Health And Human Services (DHHS) is replacing its MMIS with a more efficient, modern system that will reduce administrative burden on providers. The State DHHS is using a step-by-step, modular process to transition from the MMIS to the Replacement Medicaid Management Information System (RMMIS).

This includes the implementation of multiple system and service modules. Some of these modules have already been implemented, including the accounting and finance module, business intelligence system (BIS), pharmacy benefits administrator (PBA) module and the third-party liability (TPL) module.

The project for replacement of the State's MMIS is a major undertaking and requires major transformation of culture, processes and technology. This project also supports the State's Medicaid Management Department's transition from primarily a fee-for-service payer of claims towards a program and policy driver for health outcomes primarily through managed care programs.

The Replacement MMIS project is a multi-year effort to replace the State's aging MMIS and related applications with more modern capabilities along with corresponding business operations services. The goal of the RMMIS program will be incremental and modular in nature with a focus on configurable and scalable integrations, which allow for more flexibility and reduces the time and cost necessary to respond to federal and state enhancements. The major sub-project components of the Replacement MMIS Program are:

• Administrative Services Organization (ASO) for medical claims processing
• Pharmacy Benefits Administrator (PBA) for pharmacy claims processing
• Dental Administrative Services Organization (DASO) for dental claims processing
• Business Intelligence System
• Third-Party Liability
• Accounting and Finance – payment of medical, pharmacy, dental and MCO payments as well as other financial processing through the State SAP solution, SCEIS
• System Integration and Operations – a multi-vendor system integration and operations implementation

The current payment process involves payment processing in the current legacy MMIS and processing through a variety of non-integrating and manual processes. A key strategy of the RMMIS project is to remove these inefficiencies and transition all Medicaid payments to the State of SC SAP solution, SCEIS. This position will primarily support the Accounting and Finance project by providing expertise in business analytics and draw from experience in previous financial SAP implementations.

Daily Duties / Responsibilities: The Replacement MMIS IT MMIS Systems Integration Quality Manager (QM) will work with the Project Director and the Lead Project Manager and will support the various Project Management teams to ensure the claim solutions are coordinated with the Accounting and Finance solution. This position will serve as the Product Owner for the Accounting project for RMMIS leadership. The IT MMIS Systems Integration Quality Manager (QM) will also provide leadership expertise in the following areas for the RMMIS team:

• Risk Management
• Issue Management
• Change Management

With multiple implementations, this position is key to ensure these processes are centralized for RMMIS, tracked weekly, and well organized. These project management processes are created and maintained by the SCDHHS PMO.

Duties Include:

• Serve as primary product owner for the Accounting and Finance project, ensuring the project meets the goals and objectives of the business owner, the agency Chief Financial Officer (CFO)
• Coordinate related business transformation activities needed with the CFO and other key staff
• Coordinate project tasks and activities with the project manager
• Provide project scheduling support as needed
• Monitor, coordinate and resolve to conclusion cross-project integrations and dependencies which include RMMIS solution implementations and SCDHHS enterprise architecture considerations
• Build positive relationships with clients and proactively address specific needs
• Participate in financial and claims business design sessions within assigned modules and workstreams
• Advocate and lead business analysis in support of the Accounting and Finance project and its related impacts to the ASO, PBA, DASO, and MCO payments
• Serve as the primary risk manager for RMMIS program
• Issue management
• Change management
• Ensure RMMIS is adhering to PMO standards and governance around project processes
• Provide updates on status and issues for all assignments
• Participate in scheduled operational meetings and routine team leads meetings
• Lead cross-functional meetings and produce business designs that integrate functionality across modules
• Facilitate sessions to effectively resolve issues if any.
• Provide recommendations of appropriate resources if necessary, to ensure assignments are completed within given time and budget.

Required Skills (listed in order of importance):

• Minimum Education/Experience: Bachelor’s Degree or equivalent and at least 5 years of relevant experience.
• At least five years' experience in State Medicaid payer system integration and delivery
• At least five years of experience in major SAP financial implementations
• Five years of experience in risk management for large IT implementations
• Experience with inner workings of cross-functional projects
• Familiarity with standard MMIS data structures, electronic data interchange, processes, and related file formats.
• Interest, skill, and ability to innovate including business processes, methods/procedures, and technology.
• Ability to effectively work and communicate, in both oral and written, with all levels of the Agency from frontline workers to Executive Staff as well as the Contractor(s).
• 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 (ranked in order of importance):

• Healthcare IT
• Integrations with Medicaid or other Government operations
• Project management
• Knowledge of Federal Certification requirements and processes is preferable
• Good Verbal Communication, Written & Communication Skills
• Medicaid Management Information System (MMIS) experience
• Bachelor's degree in a technical or business field 2 - 4 Years
• Experience in major SAP financial implementations 6 + Years
• IT Healthcare Systems
• Knowledge of Federal Certification requirements and processes
• Experience working with risk management
• Project Management Experience 6 + Years

Core Competencies:

• Teamwork – ability to foster teamwork collaboratively as a participant, and effectively as a team leader
• Leadership – the ability to guide and lead colleagues on projects and initiatives
• Business Acumen – understanding and insight into how organizations perform, including business processes, data, systems, and people
• Communication – ability to effectively communicate to stakeholders of all levels orally and in writing