Medicaid Claims Operations Consultant

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.