Enterprise Architect with Medicare Medicaid Duals experience

Tata Consultancy Services; Louisville (KY); On-site; USD 120,000 - 160,000; Full time

Benefits offered by this job

Discretionary Annual Incentive

Comprehensive Medical Coverage

Family Support: Maternal & Parental Leaves

Legal Assistance

401K Plan

Performance Bonus

Vacation, Time Off, Sick Leave & Holidays

Job summary

A leading company is seeking an Enterprise Architect with specific experience in Medicare and Medicaid systems. This crucial role involves overseeing the architecture and integration of systems while ensuring compliance and enhancing workflows within the healthcare IT domain. Candidates should possess a degree in Computer Science or related fields, along with significant experience in healthcare IT.

Qualifications

• 8+ years of experience in healthcare IT, with at least 1 year in Medicaid/Medicare duals or FIDE programs.
• Strong knowledge of claims, eligibility, provider, and compliance systems.

Responsibilities

• Lead architecture and integration of FIDE plan systems including claims processing and reporting.
• Oversee enhancements for rate updates and ensure regulatory compliance.
• Collaborate to improve process and technology across systems.

Skills

Compliance

Data integrity

System integration

Education

Bachelor’s degree in Computer Science, Information Systems, or related field

Master’s degree preferred

Job description

Enterprise Architect with Medicare Medicaid Duals experience

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Enterprise Architect with Medicare Medicaid Duals experience

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• Lead the architecture and integration of FIDE plan systems, including claims processing, eligibility, provider management, and reporting platforms.
• Comprehend end-to-end workflows for dual-eligible member journeys, ensuring compliance with CMS and state requirements.
• Oversee system enhancements for rate updates, retroactive claims, and encounter data submissions.
• Collaborate with cross-functional teams to identify pain points and recommend process and technology improvements.
• Ensure auditability, data integrity, and regulatory compliance across all FIDE-related systems.
• Develop and maintain architecture documentation, data flow diagrams, and integration specifications.
• Support implementation of new markets and retrofit best practices into existing FIDE programs.
  
  
• Lead the architecture and integration of FIDE plan systems, including claims processing, eligibility, provider management, and reporting platforms.
• Comprehend end-to-end workflows for dual-eligible member journeys, ensuring compliance with CMS and state requirements.
• Oversee system enhancements for rate updates, retroactive claims, and encounter data submissions.
• Collaborate with cross-functional teams to identify pain points and recommend process and technology improvements.
• Ensure auditability, data integrity, and regulatory compliance across all FIDE-related systems.
• Develop and maintain architecture documentation, data flow diagrams, and integration specifications.
• Support implementation of new markets and retrofit best practices into existing FIDE programs.
  
  

Must Have Technical/Functional Skills

• Lead the architecture and integration of FIDE plan systems, including claims processing, eligibility, provider management, and reporting platforms.
• Comprehend end-to-end workflows for dual-eligible member journeys, ensuring compliance with CMS and state requirements.
• Oversee system enhancements for rate updates, retroactive claims, and encounter data submissions.
• Collaborate with cross-functional teams to identify pain points and recommend process and technology improvements.
• Ensure auditability, data integrity, and regulatory compliance across all FIDE-related systems.
• Develop and maintain architecture documentation, data flow diagrams, and integration specifications.
• Support implementation of new markets and retrofit best practices into existing FIDE programs.
  
  

Roles & Responsibilities

• Lead the architecture and integration of FIDE plan systems, including claims processing, eligibility, provider management, and reporting platforms.
• Comprehend end-to-end workflows for dual-eligible member journeys, ensuring compliance with CMS and state requirements.
• Oversee system enhancements for rate updates, retroactive claims, and encounter data submissions.
• Collaborate with cross-functional teams to identify pain points and recommend process and technology improvements.
• Ensure auditability, data integrity, and regulatory compliance across all FIDE-related systems.
• Develop and maintain architecture documentation, data flow diagrams, and integration specifications.
• Support implementation of new markets and retrofit best practices into existing FIDE programs.
  
  

Qualifications

• Bachelor’s degree in Computer Science, Information Systems, or related field (Master’s preferred).
• 8+ years of experience in healthcare IT, with at least 1 year in Medicaid/Medicare duals or FIDE programs.
• Strong knowledge of claims, eligibility, provider, and compliance systems.
• Experience with system integration, data management, and regulatory reporting.
  
  

Generic Managerial Skills, If any

• Collaborate with Project stakeholders and Drive the team to complete the deliverables
• Proven success working in large Medicare FDE programs
• Expertise in solving complex business functional issues, and manage the stakeholders.
• Team management
  
  

Salary Range: $120,000 - $160,000 a Year

TCS Employee Benefits Summary

Discretionary Annual Incentive.

Comprehensive Medical Coverage: Medica l & Health, Dental & Vision, Disability Planning & Insurance, Pet Insurance Plans.

Family Support: Maternal & Parental Leaves.

Insurance Options: Auto & Home Insurance, Identity Theft Protection.

Convenience & Professional Growth: Commuter Benefits & Certification & Training Reimbursement.

Time Off: Vacation, Time Off, Sick Leave & Holidays.

Legal & Financial Assistance: Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Information Technology

• Industries

  IT Services and IT Consulting

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