Solution Architect

1. Solution Architecture & Design

Design end-to-end MMIS solutions, including eligibility, claims processing, provider

management, and payment modules.

Define system architecture across application, data, and integration layers.

Develop scalable, modular, and interoperable system designs aligned with MITA (Medicaid

Information Technology Architecture) framework.

Ensure solutions align with CMS guidelines and state Medicaid regulations.

1. Technical Leadership

Provide architectural guidance to development, integration, and QA teams.

Review and approve technical designs, code, and configurations.

Lead architecture governance and design reviews.

Mentor technical teams on best practices and emerging technologies.

1. Integration & Interoperability

Design integrations with:

o Federal and State systems (CMS, HHS)

o Third-party vendors (EDI, clearinghouses)

o Healthcare systems (EHR/EMR)

Ensure adherence to interoperability standards such as:

o HL7 / FHIR

o X12 (EDI transactions)

o APIs and microservices architecture

1. Data & Analytics

Define data architecture including data flows, storage, and governance.

Ensure support for reporting, analytics, and regulatory compliance.

Oversee data migration and modernization initiatives.

1. Compliance & Security

Ensure solutions comply with:

o HIPAA

o CMS Medicaid guidelines

o State-specific requirements

Implement robust security, privacy, and audit controls.

1. Modernization & Transformation

Lead MMIS modernization initiatives (legacy transformation to cloud/microservices).

Evaluate and adopt emerging technologies (AI/automation, cloud-native design).

Support modular MMIS initiatives.

1. Stakeholder Management

Collaborate with:

o Business stakeholders

o Program managers

o State Medicaid agencies

o Vendors and implementation partners

Education

Bachelor’s or Master’s degree in Computer Science, Information Systems, or related field

Experience

10+ years of IT experience with at least:

o 5+ years in solution architecture

o 5+ years in healthcare or Medicaid systems

Proven experience working on MMIS or large healthcare payer systems

Technical Skills

Strong experience in:

o Enterprise architecture frameworks (TOGAF preferred)

o Cloud platforms (Azure/AWS/Google Cloud Platform)

o Microservices and API design

o Integration technologies (ESB, REST/SOAP)

Knowledge of:

o Medicaid domains (Claims, Eligibility, TPL, Provider Mgmt)

o EDI X12 transactions (837, 834, 835, etc.)

o HL7/FHIR

Domain Knowledge

Deep understanding of:

o Medicaid business processes

o CMS regulations and MITA framework

o Healthcare compliance standards

Preferred Skills

Experience with MMIS modernization projects

Knowledge of COTS Medicaid platforms (e.g., Conduent, Gainwell, Cognizant solutions)

Certification in:

o TOGAF / Cloud Architect (Azure/AWS)

o Healthcare IT standards

Key Competencies

Strategic thinking and problem-solving

Strong communication and stakeholder management

Leadership and mentoring

Ability to work in complex, regulated environments

Success Metrics

Successful delivery of MMIS architecture solutions

Compliance adherence (zero audit issues)

System scalability, uptime, and performance

Stakeholder satisfaction