SME, IT​/Tech

SME
Onsite:
Jackson, MS
About the Job

• Duration:
  Long term Contract Position
• Location:
  
  Onsite:
  Jackson, MS
• Pay rate:
  Hourly
• Job : 156120

Overview:
Client Looking for Provide subject matter expertise related to program data, policies and operational workflows to support the Program Integrity (PI) tool used for detecting fraud, waste and abuse.:
Responsibilities:

• Data Domain Expertise

• • Medicaid Member Data (eligibility, enrollment, demographics, coverage)
• • Managed care enrollment and attribution
• • Member identifiers and cross-system matching

Provider Data

• • Provider enrollment and credentialing
• • Provider taxonomy and specialty classifications
• • Provider affiliations and group relationships
• • National Provider Identifier (NPI) integration

Claims Data

• • Professional, institutional and pharmacy claims
• • Claim lifecycle and adjudication
• • Service codes (CPT, HCPCS, ICD, DRG)
• • Payment and encounter processing
• • Claim adjustments and resubmissions

Managed Care Data

• • MCO encounter data
• • Capitation payments
• • Managed care reporting
• • Encounter-to-claim validation

Program Integrity Support

• • Fraud, waste and abuse detection support
• • Data mapping and data model validation
• • Development of analytics rules
• • Data quality analysis and remediation
• • Defining investigative use cases
• • Medicaid policy interpretation

Implementation Support

• • Collaborate with vendors and system integrators
• • Data ingestion and transformation support
• • Data validation and reconciliation
• • Requirements gathering and design sessions
• • UAT support
• • System output validation

Stakeholders

• • Program Integrity leadership
• • Data analytics teams
• • Medicaid staff
• • IT architecture teams
• • Implementation vendors
• • Managed care oversight teams

WORK PRODUCTS

• • Data domain documentation validation
• • Data dictionary validation
• • Business rule validation
• • Data quality reports
• • System configuration documentation
• • UAT validation reports.

Qualification:
REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE): THE ABILITY TO:

• 15+ years Medicaid program data and operations
• • Experience with:
• - Member / Eligibility data
• - Provider enrollment data
• - Claims and encounter data
• - Managed care data
• • Experience with Gainwell MMIS
• • Strong Medicaid policy knowledge
• • Experience with system implementation or modernization
• • Ability to communicate technical data concepts.

Preferred/Not Required

• Provider enrollment systems
• Claims systems
• CMS reporting compliance.

About our Company
Data Soft Technologies is a highly recognized provider of professional IT Consulting services in the US. Founded in 1994, Data Soft Technologies, Inc. provides staff augmentation services for Information Technology and Automotive Services. Our team member benefits include:

• Paid Holidays/Paid Time Off (PTO)
• Medical/Dental Insurance Group
• Accident/Critical Illness Insurance
• Life Insurance
• 401 (K)