Medicaid Program SME

S R International • Jackson, MS

17h • Onsite

About The Position

The Medicaid SME will provide subject matter expertise related to Medicaid program data, policies, and operational workflows to support the successful implementation and operationalization of the Program Integrity (PI) tool. The SME will collaborate with technical teams, program staff, vendors, and project leadership to ensure the PI solution effectively leverages Medicaid data to detect, prevent, and investigate fraud, waste, and abuse.

Requirements

• Minimum of 15 years of experience working with Medicaid program data and operations
• Demonstrated expertise in the following Medicaid data domains: - Member/Eligibility data - Provider enrollment data - Claims and encounter data - Managed care program data
• Experience working with Gainwell Medicaid Management Information Systems (MMIS) or successor platforms
• Strong understanding of Medicaid program policies and regulatory requirements
• Experience supporting large system implementations or modernization projects
• Ability to communicate complex Medicaid data concepts to technical and non-technical stakeholders

Nice To Haves

• Experience implementing and managing Provider Enrollment systems
• Experience implementing claims systems and managing claims data
• Familiarity with CMS reporting and compliance requirements

Responsibilities

• Provide expert guidance related to the structure, relationships, and usage of Medicaid data domains
• Advising on data requirements for fraud, waste, and abuse detection
• Assisting with data mapping and data model validation for the PI tool
• Supporting development of analytics, rules, and investigative workflows
• Identifying data quality issues and remediation strategies
• Helping define use cases and investigative scenarios
• Ensuring accurate interpretation of Medicaid policy and program rules within the tool
• Collaborating with system integrators and vendors on data ingestion and transformation
• Supporting data validation, testing, and reconciliation
• Participating in requirements gathering and design sessions
• Providing business context for technical teams
• Reviewing system outputs for accuracy and relevance
• Supporting User Acceptance Testing (UAT)
• Program Integrity leadership
• Data analytics teams
• Medicaid program staff
• IT and data architecture teams
• System implementation vendors
• Managed Care oversight teams

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed