Medicaid Project Manager

Job Description
TEKsystems is looking for a Project Manager to lead end-to-end process transformation initiatives for a Medicaid line of business. This role will focus on optimizing claims and operational workflows, improving vendor performance, and enhancing data visibility through robust reporting and dashboard capabilities. This individual will play a critical role in understanding, defining, and improving how operational data is monitored, ensuring the right systems, metrics, and reporting structures are in place to identify issues, track performance, and drive continuous improvement across the Medicaid lifecycle.
RESPONSIBILITIES:
Program & Process Transformation
- Lead initiatives to restructure and optimize end-to-end Medicaid workflows, from intake through adjudication and downstream processes
- identify workflow inconsistencies, operational gaps, and inefficiencies, and design streamlined, scalable solutions
- Drive continuous improvement initiatives to reduce manual effort, improve processing times, and enhance quality outcomes
Claims & EDI (837) Oversight
- Understand 837 transaction processing and claims lifecycle management
- Analyze and address breakdowns across the claims flow, ensuring accuracy and minimizing rework
- Partner with various stakeholders (Medicaid Encounters team, IT, data, internal operations, etc.,) to enhance integration, mapping, and data integrity across systems
Data, Reporting, and Dashboard Development
- Define reporting requirements and KPIs to measure operational health, workflow efficiency, and error rates
- Partner with analytics and IT teams to design, build, and enhance dashboards that provide actionable insights
- Ensure dashboards accurately reflect end-to-end process performance and key operational metrics
- Evaluate existing reporting structures to identify gaps in visibility, accuracy, or timeliness, and implement improvements
- Translate business needs into data and reporting solutions that enable proactive decision-making
System Monitoring & Operational Visibility
- Understand various systems, tools, and data sources used to monitor across the Medicaid operational ecosystem
- Determine monitoring feasibility (what can and cannot be tracked) and develop strategies to close visibility gaps
- Establish processes and frameworks to ensure consistent monitoring of workflows, transactions, and system performance
- Collaborate with IT and business teams to improve system-level tracking, alerts, and reporting capabilities
- Ensure transparency across systems to enable early identification of issues and performance bottlenecks
Error Identification & Issue Management
- Develop mechanisms to uncover, track, and manage errors across the entire end-to-end process
- Implement structured approaches for root cause analysis and long-term remediation
- Monitor error trends and leverage reporting insights to prevent recurring issues and improve outcomes
Vendor Management
- Assist in overseeing vendor relationships supporting Medicaid operations
- Monitor vendor performance using data-driven metrics and dashboards
- Drive accountability through SLA tracking and continuous improvement initiatives
- Partner with vendors to enhance workflows, improve service levels, and address operational challenges
Stakeholder Collaboration
- Collaborate cross-functionally with operations, IT, compliance, and vendor teams
- Facilitate working sessions to identify reporting needs, system gaps, and process improvements
- Communicate insights, risks, and performance trends to leadership through clear, data-driven storytelling

QUALIFICATIONS:

- Experience in healthcare payer operations, with strong Medicaid experience preferred
- Process optimization and workflow redesign;
Problem-solving & root cause analysis
- Experience managing cross-functional programs and transformation initiatives
- Strong understanding of claims processing, 837 transactions, and operational workflows
- Experience in reporting, dashboard development, or data-driven performance management
- Ability to understand system architecture and data flow across multiple platforms
- Proven ability to identify and resolve process, system, and reporting gaps
- Knowledge of Medicaid regulations and compliance requirements a plus but not required
Job Type & Location
This is a Contract to Hire position based out of Honolulu, HI.
Pay and Benefits
The pay range for this position is $40.00 - $58.00/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
Medical, dental & vision
Critical Illness, Accident, and Hospital
401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available
Life Insurance (Voluntary Life & AD&D for the employee and dependents)
Short and long-term disability
Health Spending Account (HSA)
Transportation benefits
Employee…