Medicaid Systems Operations Manager - MMIS...
Role details
Job location
Tech stack
Job description
HTC is seeking an IT Healthcare Project Manager to lead MMIS Medicaid Systems Operational Management. This role oversees business-critical operations supporting MCO enrollment, claims and encounter processing, payment functions, and related support systems. The environment is fast-paced and requires participation in after-hours support for system releases and unplanned incidents., + Lead MMIS systems operational management, including replacement systems as they are implemented.
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Oversee, coordinate, and perform operational support activities for MMIS, Encounter Processing System, and supporting systems.
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Coordinate with vendors, the Office of Cyber Security, Enterprise Architecture, and other stakeholders.
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Lead teams providing production support, helpdesk services, interface/EDI support, and stakeholder monitoring.
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Oversee incident and issue management, including documentation, tracking, escalation, and resolution of production issues.
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Identify and mitigate operational issues while ensuring decisions and actions are properly documented.
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Manage internal and external escalations and ensure timely, effective resolution.
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Ensure work is assigned appropriately and operational issues are resolved efficiently.
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Ensure compliance with security requirements (CMS, SSA, etc.) and monitor findings and recommendations through completion.
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Work with the contract monitor to establish and monitor service level agreements (SLAs).
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Respond promptly to inquiries.
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Promote workforce engagement and maintain a safe, professional, and productive work environment.
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Implement, monitor, and enforce Standard Operating Procedures (SOPs), and communicate when practices differ from established procedures.
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Oversee release management activities, including stakeholder communication, pre-implementation planning, readiness checks, and post-implementation monitoring.
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Support change management by coordinating backlog grooming and maintenance and ensuring compliance with required approval processes.
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Provide after-hours and on-call support for incidents and system releases as needed.
Requirements
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Bachelor's degree in a technical, business, or healthcare field, or 5+ years of equivalent experience in business/systems analysis and/or computer systems development/modification.
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5+ years of experience managing system operations and/or administrative program functions for claims and/or encounter processing in a healthcare environment.
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5+ years of project management experience managing system implementations or enhancements.
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3+ years of experience managing external vendors providing system development.
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Ability to provide incident management on-call and after hours.
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AWS Cloud Certifications.
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Excellent communication skills with staff ranging from frontline personnel to executive management.
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Ability to manage work and provide guidance.
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Experience assigning and overseeing team workload.
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Knowledge of the system development lifecycle.
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Strong documentation and process management skills.
Preferred Qualifications
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Prior experience managing operations of Medicaid Enterprise systems.
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Knowledge of Medicaid eligibility, enrollment, and MMIS domain concepts.
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Experience with ticketing software.
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Experience writing Standard Operating Procedures for new system implementations.
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Ability to make presentations and prepare reports.