NTT

2 months ago

Medicaid Claims Operations Consultant

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Last checked: 17 hours agoStatus: Live

Job Summary

Provide operational coordination and guidance for Medicaid MMIS initiatives, including planning and executing transition to CPMS and EDS. Partner with client program managers on changes leading up to cutover, including operational readiness for claims processing, payment cycles, provider enrollment, call centers, prior authorization, pharmacy operations, and EDI. Act as a primary functional liaison across agency and vendors, review deliverables, and support Operational Readiness Review preparation with CMS.

Location: United States

Workplace: Onsite

Employment Type: Full time

Job Function: Consulting & Advisory

Key Responsibilities

•Provide operational advice for the transition to CPMS and ongoing implementation of major changes affecting MES operations, focusing on claims processing readiness and business continuity.
•Advise program and project leadership on operational readiness, phase gate reviews, risks, and go-live considerations.
•Review and advise on MMIS change pipeline alignment with operational processes to minimize disruption.
•Coordinate with program managers and certification leadership to ensure UAT completion readiness for Operational Readiness Review (ORR).
•Serve as the primary functional liaison between the agency, incumbent MMIS contractor, EDS contractor, and CPMS contractor on operational matters, including reviewing deliverables and identifying risks/issues/action items.

Key Requirements

•Minimum 10 years of experience with medium-to-large healthcare IT programs.
•Minimum 5 years of recent experience in MMIS operations, including claims processing lifecycle, provider management, mailroom operations, and call centers.
•Demonstrated experience with system transition or platform replacement (data center to cloud) and vendor transition (incumbent to new vendor).
•Bachelor’s degree or equivalent work experience.
•Preferred knowledge of MMIS claims processing and Medicaid business workflows (claims, payments, provider interactions).

Experience:10+ yearsHealthcare ITMedicaidMMISHealthcareClaims processing

Education:Bachelor's

Skills:Operational readinessStakeholder communicationRisk managementChange managementProcess improvement

Tech Stack:MMISCPMSEDSCMSUATInterchangeEDI

Company Brief

NTT

Dimension Data, operating under NTT Ltd, provides managed IT services, cloud and data center solutions, networking, cybersecurity, and digital transformation services to enterprise customers worldwide.

Industry: Professional Services

Company Size: Enterprise (1,001+ employees)

Revenue: USD 1B+

Growth: Established Company

Valuation: Public Company (Market Cap in USD)

Headquarters: London, United Kingdom

Founded: 1983

Website LinkedIn

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NTT