The Medicaid Subject Matter Expert (SME) provides specialized knowledge and guidance in Medicaid program operations, policy, compliance, and regulatory alignment. This role involves validating solution alignment, assessing compliance, reviewing workflows, and identifying risks within Medicaid programs.
Location:Virginia, United States
Responsibilities:
- Validate solution alignment with Medicaid operational requirements.
- Assess compliance with CMS standards.
- Review claims processing workflows.
- Evaluate eligibility and fiscal agent processes.
- Validate reporting compliance requirements.
- Identify regulatory and operational risks.
- Participate in business process reviews.
- Support validation of policy-driven system requirements.
Required Skills & Certifications:
- Minimum 7 years of experience in Medicaid program operations.
- Minimum 7 years of experience in Medicaid policy.
- Minimum 7 years of experience in regulatory compliance.
Preferred Skills & Certifications:
- CMS Medicaid Enterprise Certification experience.
- Healthcare compliance training.
- CHC (Certified in Healthcare Compliance).
- Lean Six Sigma (process improvement advantage).
Special Considerations:
- N/A
Scheduling:
- N/A
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