DAILY DUTIES / RESPONSIBILITIES: A Replacement MMIS Subject Matter Expert (SME) is responsible for evaluating agency needs, as-is and to-be business processes, and technical designs to provide analysis and advice on strategies for information technology solutions and non-technical solutions. The majority of the system development work will be outsourced to vendors and other State organizations.
• Requirements development execution, including the elicitation, analysis, specification and validation.
• Documenting and analyzing agency business processes and recommending improvements.
• Documenting and analyzing data requirements and relationships.
• Participate in the requirements management processes, including change control; version control; tracking and status reporting; and traceability.
• Providing requirement interpretation and guidance to technical and test teams.
• Proactively identifying risks, issues, and action items leading to possible solutions.
• Interacting with internal and external organizations (i.e. vendors, State and Federal government agencies, State providers and beneficiaries, and other stakeholders).
• Planning for, conducting, and reporting on testing and other quality assurance activities.
• Other related activities.
Subject matter areas include: provider management, member (beneficiary) management/eligibility, claims (professional, institutional, pharmacy, dental, durable medical equipment, transportation, etc.), third party liability, financial management, reimbursement methodology, drug rebate, prior authorization, managed care, behavioral health, long-term care, program integrity, electronic health records, benefit plan administration, etc.
Familiarity with ICD-9/ICD-10 coding standards, X12 EDI transactions, and the Affordable Care Act and it impacts on Medicaid eligibility and health insurance