Job ID: NC-645833 (96590506)
Location: Raleigh NC (NCDHHS)
Duration: 12 months
Interview: Either Webcam Interview or In Person
Positions: 1 (1/1)
Experience working with multiple vendors Required
Should have the capability to translate business requirements into technical solutions Required 5 Years
Project Management Experience Required 5 Years
Strong understanding of healthcare claims processing – Claims, Provider, Eligibility Highly desired
Working knowledge of Medicaid and/or MMIS Highly desired
Excellent verbal and written communication skills with the ability present to both technical and business audiences. Highly desired
Proven experience delivering Business Intelligence solutions Desired
Experience with Agile methodology and Scrum Required 5 Years
Demonstrated proficiency working with databases – Oracle (11) ,MS Sql server etc. DB2 Required 5 Years
NC Dept of Health and Human Services (NC DHHS) is seeking an Operations Lead to coordinate with multiple vendors for daily operations and enhancements of Electronic Visit Verifications for the NC Medicaid Claims Systems.
This position is responsible for providing vendor coordination and operational support for the day to day operations and enhancements to the Electronic Visit Verification (EVV) system and all related NC Medicaid and NC Analytics Systems which are currently handled by different vendors. It will involve coordinating and managing multiple vendors and stakeholders in creating and validating input files and formats as per the data mapping artifacts, architecting output datasets and validating data based on the requirements; quality assurance of data and interaction with division/federal staff to resolve data quality issues and manage all data extracts based on the policies and standards.
This position involves the ability to research and analyze complex healthcare data from variety of sources in order to evaluate, define, design, develop, test and implement technical solutions related to Electronic Visits and Medicaid systems to produce accurate data extracts in the required file layouts based on the Federal requirements.
This position is also responsible for analyzing and data mapping utilizing data and information from Electronic Visit Verification system, Data warehouse, Medicaid claims processing system (MMIS – Claims, Eligibility, provider etc, Encounter Processing system(PHP-Encounters), PBM (RX Claims) and other division data sources using various SAS Business Intelligence tools.
This position will need to work with Division staff and other stakeholders to understand the requirements and providing technical support/guidance. Knowledge and ability for utilizing secured file transfer protocols/process compliant with the defined Federal standards.
This position will require the following Skills
-Demonstrated experience managing Operations across multiple vendors – Required
-Experience working with complex interfaces and integrations – Required
-Proven experience delivering Business Intelligence solutions
-Proven experience with Medicaid data and systems
-Experience with Agile development methodology and Scrum – Required
-Demonstrated proficiency working with one or more databases – Oracle, DB2, MS SQL server etc.- Required
-Hands-on experience in different file transfer methodologies and different file types and layouts such as csv, txt, XML, etc.