Serve as the Subject Matter Expert (SME) for Medicaid claims processing and encounter data systems.
Provide expert-level knowledge of the Medicaid claims life cycle, including HIPAA X12 transactions (837, 835) and NCPDP formats.
Collaborate with cross-functional teams (IT, QA, Business Analysts) to ensure accurate implementation of Medicaid requirements.
Analyze and interpret Medicaid policy changes and translate them into detailed system requirements.
Support testing, validation, and quality assurance of Medicaid claims software applications.
Develop and maintain documentation, training materials, and process workflows.
Participate in audits, compliance reviews, and quality assurance initiatives.
Provide mentorship and guidance to junior team members and stakeholders.

Bachelor’s degree in healthcare administration, Information Systems, or a related field (Master’s preferred).
5+ years of experience in Medicaid claims processing or healthcare IT systems.
Strong understanding of Medicaid regulations, policies, and managed care programs.
Proficiency with Medicaid Management Information Systems (MMIS) and encounter data systems.
Experience with claims adjudication systems and Electronic Data Interchange (EDI).
Familiarity with CMS guidelines and state-specific Medicaid programs.
Strong analytical, problem-solving, and communication skills.
Ability to work independently and manage multiple priorities in a fast-paced environment.

Technology Solutions Management Consultant

Key skills