Description

You will lead the architecture and integration of FIDE plan systems, including claims processing, eligibility, provider management, and reporting platforms.

Responsibilities

• Lead the architecture and integration of claims, eligibility, provider management, and reporting systems.
• Design end-to-end workflows for dual-eligible member journeys to ensure CMS and state compliance.
• Oversee system enhancements for rate updates, retroactive claims, and encounter data submissions.
• Develop and maintain architecture documentation, data flow diagrams, and integration specifications.
• Collaborate with cross-functional stakeholders to identify pain points and implement process or technology improvements.
• Ensure data integrity, auditability, and regulatory compliance across all FIDE-related systems.

Required Skills

• 8+ years of experience in healthcare IT.
• At least 1 year of experience specifically in Medicaid/Medicare duals or FIDE programs.
• Proven experience working in large Medicare FDE programs.
• Deep knowledge of claims, eligibility, provider, and compliance systems.
• Expertise in system integration, data management, and regulatory reporting.
• Ability to solve complex business functional issues and manage stakeholders.
• Experience managing teams and driving project deliverables.
• Bachelor’s degree in Computer Science, Information Systems, or a related field.

Preferred Skills

• Master's degree in a related technical field.

Key Skills

Education

Bachelor's or Master's degrees