MMIS (Medicaid Management Information Systems) Domain Lead

· The Domain Lead bridges business, policy, and technical execution across one or more functional domains within MMIS Medicaid Management Information Systems (MMIS) and/or the Medicaid Pharmacy environment. Supported domains may include Member, Provider, Claims (Medicaid, Dental, and/or Pharmacy), Finance, Plan and Care Management, and Business Relationship Management.

· This role owns end-to-end delivery for assigned domain(s), translating state and federal Medicaid policy and program requirements into product features, system configuration, and design decisions.

· The Domain Lead leads work across requirements, design, configuration, testing, deployment, and hypercare, partnering with cross-functional teams to ensure successful implementation and operational readiness.

Key Responsibilities

Requirements & Design

· Acts as the primary Domain SME, serving as a trusted advisor to the Engagement Lead (EL) on business processes and associated regulatory and operational impacts.

· Ensures compliance alignment by validating that solution design and configuration conform to CMS guidance, state policy, and documented business rules.

· Supports the EL with in-scope negotiations and change control, providing domain expertise to assess scope tradeoffs and the functional, regulatory, and operational impacts of change requests.

· Own requirements and design sessions to validate functional and technical needs, ensuring alignment with policy, business objectives, and product capabilities.

· Translate state and federal Medicaid policy, regulations, and program rules into product features, system configuration, business rules, and design artifacts.

· Own end-to-end domain design, with the Design Document as the primary approved deliverable, covering all functionality mapped to the product and supporting applications, including workflows, interfaces, X12 EDI transactions, letters, and reports.

· Ensure accuracy, completeness, and traceability of requirements and acceptance criteria.

· Manage and document domain level decisions, risks, assumptions, and dependencies and assess downstream impacts.

Build / Configuration

· Lead domain specific configuration and implementation activities within Design, Development, and Implementation (DDI) projects.

· Ensure all configuration aligns with approved design documents, Medicaid policy interpretation, and documented business rules. Key configurations include but not limited to:

o Claims: Edits, pricing, benefit limits,, adjudication logic

o Plan: Contracts, benefits, programs, fee schedules

o Provider: Provider types, specialties, contracts, enrollment, credentialing

o Member: Eligibility, benefits, benefit plans, demographic

o Pharmacy: RX benefits, RX claims processing

· Review and validate unit test results, coordinate post-build demonstrations, and support configuration governance and change control processes.

Testing

· Review test cases to ensure alignment with requirements, policy interpretation, and acceptance criteria.

· Provide domain subject matter expertise during System Integration Testing (SIT) and User Acceptance Testing (UAT).

· Support defect analysis, resolution, retesting, and functional readiness validation.

Operational Readiness & Deployment

· Support operational readiness activities, including environment, data, process, and staffing readiness.

· Provide domain input for Operational Readiness Reviews (ORR), parallel testing, performance testing, and cutover planning.

· Support transition to operations and hypercare readiness.

Communication, Leadership & Project Support

· Lead and guide a team of Business Analysts, Configuration Analysts, and Technical Analysts, serving as the primary domain subject matter expert (SME).

· Communicate design decisions, risks, and impacts clearly and effectively to stakeholders.

· Ensure domain deliverables are completed on time and meet quality standards.

· Support knowledge transfer, documentation, and mentoring of junior team members.

· Bachelor’s degree in Computer Science, Information Systems, Health Informatics, or a related field.

· 5+ years of hands-on experience delivering healthcare system implementations, including MMIS solutions and Medicaid Pharmacy platforms.

· Hands-on experience with QNXT or similar healthcare claims/encounter management systems.

· Strong understanding of Medicaid programs, including claims, member, provider, and prior authorization processes.

· Demonstrated experience translating policy or program rules into system configuration and technical design.

· Strong knowledge of SQL is required.

· Strong communication and documentation skills.

· Experience working in SDLC and Agile delivery environments.

Preferred Qualifications

· Knowledge of MITA (Medicaid Information Technology Architecture).

· Experience with system integrations, EDI/X12 transactions, data analytics, and reporting.

· Familiarity with state and federal healthcare regulations and compliance standards.

This position pays a strong salary package with full benefits (including choice of healthcare plans, dental, vision, life insurance, 3 weeks PTO, 11 Paid Federal Holidays, and a matching 401k).

An option for working on an hourly rate is also available for those not needing a full benefits package.