Deputy Director, Business & Systems Integration

About the position

The MassHealth Business & Systems Integration (BSI) Unit is the bridge between MassHealth business staff (operations & program) and the technical teams & the primary system that support them. There are three key responsibilities: 1) BSI ensures that the Medicaid Management Information System (MMIS) which is the primary technology system for claims adjudication, member eligibility, provider enrollment, and accountable care health plan enrollment and maintenance, meets functional business needs prioritized by agency staff and regulatory requirements. BSI develops and maintains the functional roadmap for MMIS which outlines the business' systems development needs and is responsible for the look & feel of the base application and the provider portal. 2) BSI oversees external user access to the MMIS Provider Online Service Center (POSC), Robotics Processing Automation (RPA), and access to Electronic Data Interchange (EDI) transactions. 3) BSI coordinates crucial activities between business and technical staff to ensure alignment and collaboration throughout key components of the software development lifecycle (e.g., business requirements); partner with MMIS to facilitate key technical initiatives (e.g., system migrations, upgrades, etc.), and coordinate with business and technical staff to facilitate system operations issues (such as responding to outages, cyber security incidents, management of Continuity of Operations Plans [COOP]). BSI delivers on its objectives guided by a keen sense of what the business needs balanced with a thorough understanding of, and ensures compliance with, federal administrative simplification and interoperability requirements. This includes the Health Insurance Portability and Accountability Act (HIPAA) and other federal regulations (such as CMS Interoperability standards). Reporting to the Director of BSI, MassHealth is seeking qualified applicants to apply for the exciting, hands-on position of Deputy Director of Business & Systems Integration (BSI). The Deputy Director assists the Director in all aspects of managing the BSI unit. This person is primarily responsible for day-to-day operational excellence in all BSI processes and policies and provides strategic guidance on business/technology coordination. The right candidate has the ability to 1) understand business customer needs and what that means for technical functionality, 2) deepen mutual understanding and collaboration across diverse teams, 3) drive operational efficiency, 4) develop a strategic perspective on the technology product roadmap, and 5) translate regulatory requirements into proposed business and technology changes. This is an exciting role in a team that sits at the nexus of technical innovation and product delivery at MassHealth. With great performance, this role has significant upward mobility and scope expansion opportunities.

Responsibilities

• Manage user access related to the provider portal; this includes oversight of BSI staff to respond to portal permissions issues, management of the user access policy and related initiatives; management of robotics processing automation policy; identification and implementation of initiatives to strengthen policies and adhere to industry standards.
• Oversee business management of electronic data interface (EDI) transactions, including support vendor activities, issue escalations, and future-looking strategy (such as decisions/tradeoffs around transaction formats); identify, communicate, and manage the implementation of new business processes and systems modifications to ensure data interoperability and HIPAA compliance in accordance with state and federal regulations.
• Manage functional integration coordination activities across MassHealth, throughout the Systems Development Life Cycle (SDLC) to ensure alignment between business and technical staff and that business needs are met.
• Provide business leadership and management of the General subsystem within MMIS; ensure a consistent look & feel of the system, provide guidance on security protocols, facilitate key components of the cyber security incident response plan, and manage the subordinate ID security access functions.
• Collaborate with the BSI Director to establish unit goals and priorities and to support large scale implementation efforts.

Requirements

• Demonstrated experience in the management of business operations within a large healthcare organization (e.g., commercial payer, Medicare, Medicaid).
• Demonstrated experience coordinating activities between business and technical staff throughout the Systems Development Life Cycle (SDLC) to support and/or lead the implementation of functional requirements.
• Knowledge of the federally mandated Health Insurance Portability and Accountability Act (HIPAA) healthcare transactions, interoperability standards, and other Electronic Data interchange (EDI) industry standard best practices.
• Excellent communication, presentation, and interpersonal skills with the ability to effectively collaborate with diverse teams, stakeholders, and communicate across all levels of a healthcare organization.
• Strong problem-solving skills and the ability to analyze issues, think through problems, organize information, key factors and underlying causes, and identify & implement resolution approaches.
• Ability to work cooperatively with others and be part of a team.

Nice-to-haves

• Demonstrated experience evaluating CMS administrative simplification federal mandates and related policies, assessing the impact of the mandate to a healthcare organization and documenting the findings.
• Demonstrated experience managing the implementation or modification of industry standard HIPAA transactions and other large-scale systems modifications within a healthcare organization.
• Demonstrated experience managing COOPs, cyber security issues, robotics processing automation, and/or user access controls and policies.

Benefits

• Comprehensive benefits package including health insurance, retirement plans, and paid time off.
• Opportunities for professional development and career advancement.
• Supportive work environment that values diversity and inclusion.