Decimal Systems Online Training US Jobs - Los Angeles, CA

Daily Duties / Responsibilities:
A Replacement MMIS Subject Matter Expert (SME) is responsible for evaluating agency needs, as-is and to-be business processes, and technical designs to provide analysis and advice on strategies for information technology solutions and non-technical solutions. The majority of the system development work will be outsourced to vendors and other State organizations.

Duties include:
· Requirements development execution, including the elicitation, analysis, specification and validation.
Documenting and analyzing agency business processes and recommending improvements.
Documenting and analyzing data requirements and relationships.
· Participate in the requirements management processes, including change control; version control; tracking and status reporting; and traceability.
· Providing requirement interpretation and guidance to technical and test teams.
· Proactively identifying risks, issues, and action items leading to possible solutions.
Interacting with internal and external organizations (i.e. vendors, State and Federal government agencies, State providers and beneficiaries, and other stakeholders).
Planning for, conducting, and reporting on testing and other quality assurance activities.
Other related activities.

Subject matter areas include: provider management, member (beneficiary) management/eligibility, claims (professional, institutional, pharmacy, dental, durable medical equipment, transportation, etc.), third party liability, financial management, reimbursement methodology, drug rebate, prior authorization, managed care, behavioral health, long-term care, program integrity, electronic health records, benefit plan administration, etc.

Familiarity with ICD-9/ICD-10 coding standards, X12 EDI transactions, and the Affordable Care Act and it impacts on Medicaid eligibility and health insurance exchanges is also beneficial.