Medicaid Claims Operations Consultant

Req ID: 373305 

NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now.

We are currently seeking a Medicaid Claims Operations Consultant to join our team in Montgomery, Alabama (US-AL), United States (US).

Overview of job: 

The Medicaid Claims Operations Consultant  provides coordination and support for MES existing MMIS initiatives affecting operations related to the modernization of the MMIS and planning and support for the transition to the new Claims Processing and Management Services (CPMS) and Enterprise Data Services (EDS) environment and structure.   Works directly with client CPMS and EDS program manager(s) on planning and executing changes to the existing system in preparation for cutover to the CPMS and EDS.   The Operations Lead will provide guidance and insight on the operational aspects of migrating the Fiscal Agent responsibilities to the CPMS vendor.  These include transition to a new location, if needed, transition and cutover of operational units including call center, provider enrollment, mail room, prior authorization units, pharmacy operations, and EDI operations.  The Operations Lead will work with Business Analysts from the Agency and NTT DATA on activities in both the AMMIS system and the CPMS necessary for the effective transition.  The Operations Lead will work with the CPMS and EDS project managers and program managers to prepare and execute the Operational Readiness Review with CMS.    Additionally, this individual will aid the client in maintaining the relationship with the existing MMIS contractor and work with the CPMS and EDS contractors to ensure a successful transition.  General responsibilities include status reporting, meeting facilitation, and other project related services, at the direction of the NTT DATA contract leadership. 

Job Responsibilities Include: 

• Provide operational advice to the Agency for the transition to the new CPMS and ongoing for the implementation of major changes affecting MES operations. Focusing on readiness for claims processing, payment cycles, provider enrollments and business continuity.
• Advise program and project leadership on operational readiness, phase gate reviews, risks, and go-live considerations. focusing on readiness for claims processing, payment cycles, provider enrollments and business continuity.
• Review and advise on MMIS change pipeline to ensure alignment with operational processes to minimize disruption.
• Work with Program Managers and Certification Lead to stay aligned and assist in getting UAT complete to prepare for a successful ORR.
• Support cross-module coordination by identifying operational dependencies and gaps impacting transition readiness
• Support post-production certification efforts related to operations. 
• Act as the primary functional liaison between the Agency, incumbent MMIS contractor, EDS contractor, and CPMS contractor on operational matters.
• Review and comment on relevant schedules and deliverables.
• Identify Risk, Issues, Action Items, and Decisions.
• Manage scope, quality, and stakeholder communication.
• Manage submission of relevant deliverables.
• Ensuring that AMMP PMO processes and procedures are followed.

• Coordinate and validate completeness and accuracy of knowledge transfer and operational documentation from the incumbent vendor to the new vendor and internal teams.
• Identify and escalate operational risks and impacts related to CPMS claims processing, vendor transition, and certification.
• Consult with the Agency and the contractors on best practices in change management, testing, quality management and architecture.
• Provide suggestions for improvements in operational efficiency and accuracy.

Basic Qualifications: 

• A minimum of ten (10) years of experience with medium-to-large-sized healthcare IT programs

• A minimum of five (5) years’ recent experience in MMIS operations specifically, in Claims processing lifecycle, provider management, mailroom operation and call centers.  reimbursement and financial operations, with a preference for experience with Interchange.

• Demonstrated experience in system transition or platform replacement (data center to cloud) and vendor transition (incumbent to new vendor).

• Bachelor’s degree, or equivalent work experience.

Preferred Skills: 

• Strong understanding of MMIS claims processing and Medicaid business workflows (claims, payments, provider interactions)
• Ability to assess operational impacts of system changes across integrated MES modules
• Knowledge of CMS certification expectations (OBC/SMC) and MITA framework
• Ability to evaluate transition risks and ensure operational readiness for large-scale system changes
• Familiarity with cloud-based architecture and data/integration patterns in Medicaid environments

Certifications (Preferred):
PMP, ITIL, or equivalent industry certifications

Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting pay range for this remote role is $110,625 - $175,000. This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on a number of factors, including the candidate’s actual work location, relevant experience, technical skills, and other qualifications.

This position is eligible for company benefits including medical, dental, and vision insurance with an employer contribution, flexible spending or health savings account, life and AD&D insurance, short and long term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally-required benefits.

About NTT DATA

NTT DATA is a $30 billion business and technology services leader, serving 75% of the Fortune Global 100. We are committed to accelerating client success and positively impacting society through responsible innovation. We are one of the world's leading AI and digital infrastructure providers, with unmatched capabilities in enterprise-scale AI, cloud, security, connectivity, data centers and application services. our consulting and Industry solutions help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have experts in more than 50 countries. We also offer clients access to a robust ecosystem of innovation centers as well as established and start-up partners. NTT DATA is a part of NTT Group, which invests over $3 billion each year in R&D.

Whenever possible, we hire locally to NTT DATA offices or client sites. This ensures we can provide timely and effective support tailored to each client’s needs. While many positions offer remote or hybrid work options, these arrangements are subject to change based on client requirements. For employees near an NTT DATA office or client site, in-office attendance may be required for meetings or events, depending on business needs. At NTT DATA, we are committed to staying flexible and meeting the evolving needs of both our clients and employees. NTT DATA recruiters will never ask for payment or banking information and will only use @nttdata.com and @talent.nttdataservices.com email addresses. If you are requested to provide payment or disclose banking information, please submit a contact us form, https://us.nttdata.com/en/contact-us.

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