Medicaid Systems Operations Manager - MMIS & Claims

HTC Global Services Inc • Columbia, MO • 1w ago

Job Title: IT Healthcare Project Manager - Medicaid MMIS Operations

Overview / Summary

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.

Key Responsibilities

Lead MMIS systems operational management, including replacement systems as they are implemented.

Oversee, coordinate, and perform operational support activities for MMIS, Encounter Processing System, and supporting systems.

Coordinate with vendors, the Office of Cyber Security, Enterprise Architecture, and other stakeholders.

Lead teams providing production support, helpdesk services, interface/EDI support, and stakeholder monitoring.

Oversee incident and issue management, including documentation, tracking, escalation, and resolution of production issues.

Identify and mitigate operational issues while ensuring decisions and actions are properly documented.

Manage internal and external escalations and ensure timely, effective resolution.

Ensure work is assigned appropriately and operational issues are resolved efficiently.

Ensure compliance with security requirements (CMS, SSA, etc.) and monitor findings and recommendations through completion.

Work with the contract monitor to establish and monitor service level agreements (SLAs).

Respond promptly to inquiries.

Promote workforce engagement and maintain a safe, professional, and productive work environment.

Implement, monitor, and enforce Standard Operating Procedures (SOPs), and communicate when practices differ from established procedures.

Oversee release management activities, including stakeholder communication, pre-implementation planning, readiness checks, and post-implementation monitoring.

Support change management by coordinating backlog grooming and maintenance and ensuring compliance with required approval processes.

Provide after-hours and on-call support for incidents and system releases as needed.

Required Qualifications

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.

5+ years of experience managing system operations and/or administrative program functions for claims and/or encounter processing in a healthcare environment.

5+ years of project management experience managing system implementations or enhancements.

3+ years of experience managing external vendors providing system development.

Ability to provide incident management on-call and after hours.

AWS Cloud Certifications.

Excellent communication skills with staff ranging from frontline personnel to executive management.

Ability to manage work and provide guidance.

Experience assigning and overseeing team workload.

Knowledge of the system development lifecycle.

Strong documentation and process management skills.

Preferred Qualifications

Prior experience managing operations of Medicaid Enterprise systems.

Knowledge of Medicaid eligibility, enrollment, and MMIS domain concepts.

Experience with ticketing software.

Experience writing Standard Operating Procedures for new system implementations.

Ability to make presentations and prepare reports.

What Makes HTC A Great Place To Build Your Future

HTC Global Services wants you to join our team. Come build new things with us and advance your career. At HTC Global, you'll collaborate with experts, work alongside clients, and be part of high-performing teams driving success together. You'll have long-term opportunities to grow your career and develop skills in the latest emerging technologies.

At HTC Global Services, our employees have access to a comprehensive benefits package. Benefits can include Group Health (Medical, Dental, and Vision), Paid Time Off, Paid Holidays, 401(k) matching, Group Life and Disability insurance, Professional Development opportunities, Wellness programs, and a variety of other perks.

Our success as a company is built on inclusion and diversity. HTC Global Services is committed to providing a workplace free from discrimination and harassment, where every employee is treated with dignity and respect. We celebrate differences and believe that diverse cultures, perspectives, and skills drive innovation and success. HTC is an Equal Opportunity Employer and a proud National Minority Supplier. We seek to empower each individual, fostering an environment where everyone feels valued, included, and respected.

LI-SK9 #Hiring #LI-Onsite

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