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SME

Datasoft Technologies

Jackson, MS

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JOB DETAILS
SKILLS
Acceptance Testing, Adjudication, Automotive Repair and Maintenance, Claims Processing, Communication Skills, Content Management Systems (CMS), Current Procedural Terminology (CPT), Data Analysis, Data Management, Data Mapping, Data Modeling, Data Quality, Demographics, Diagnosis-Related Group (DRG), Healthcare Common Procedure Coding System (HCPCS), Information Architecture, Information Technology & Information Systems, Information Technology Consulting, International Classification of Diseases (ICD), Leadership, Managed Care, Medicaid, Model Validation, Operational Support, Payment Processing, Pharmacy, Product/Service Launch, Professional Services, Provider Credentialing, Reconciliation, Requirements Management, Sales/Support Engineering (SE), System Integration (SI), System Validation, Taxonomies, Team Lead/Manager, Use Cases, Validation Documentation
LOCATION
Jackson, MS
POSTED
30+ days ago
SME
Onsite: Jackson, MS
About the Job
  • Duration: Long term Contract Position
  • Location: Onsite: Jackson, MS
  • Pay rate: Hourly
  • Job ID: 156120
Overview:
Client Looking for Provide subject matter expertise related to program data, policies and operational workflows to support the Program Integrity (PI) tool used for detecting fraud, waste and abuse.:
Responsibilities:
  • Data Domain Expertise
  • • Medicaid Member Data (eligibility, enrollment, demographics, coverage)
  • • Managed care enrollment and attribution
  • • Member identifiers and cross-system matching
Provider Data
  • • Provider enrollment and credentialing
  • • Provider taxonomy and specialty classifications
  • • Provider affiliations and group relationships
  • • National Provider Identifier (NPI) integration
Claims Data
  • • Professional, institutional and pharmacy claims
  • • Claim lifecycle and adjudication
  • • Service codes (CPT, HCPCS, ICD, DRG)
  • • Payment and encounter processing
  • • Claim adjustments and resubmissions
Managed Care Data
  • • MCO encounter data
  • • Capitation payments
  • • Managed care reporting
  • • Encounter-to-claim validation
Program Integrity Support
  • • Fraud, waste and abuse detection support
  • • Data mapping and data model validation
  • • Development of analytics rules
  • • Data quality analysis and remediation
  • • Defining investigative use cases
  • • Medicaid policy interpretation
Implementation Support
  • • Collaborate with vendors and system integrators
  • • Data ingestion and transformation support
  • • Data validation and reconciliation
  • • Requirements gathering and design sessions
  • • UAT support
  • • System output validation
Stakeholders
  • • Program Integrity leadership
  • • Data analytics teams
  • • Medicaid staff
  • • IT architecture teams
  • • Implementation vendors
  • • Managed care oversight teams
WORK PRODUCTS
  • • Data domain documentation validation
  • • Data dictionary validation
  • • Business rule validation
  • • Data quality reports
  • • System configuration documentation
  • • UAT validation reports.

Qualification:
REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE): THE ABILITY TO:
  • 15+ years Medicaid program data and operations
  • • Experience with:
  • - Member / Eligibility data
  • - Provider enrollment data
  • - Claims and encounter data
  • - Managed care data
  • • Experience with Gainwell MMIS
  • • Strong Medicaid policy knowledge
  • • Experience with system implementation or modernization
  • • Ability to communicate technical data concepts.
Preferred/Not Required
  • Provider enrollment systems
  • Claims systems
  • CMS reporting compliance.
About our Company
DataSoft Technologies is a highly recognized provider of professional IT Consulting services in the US. Founded in 1994, DataSoft Technologies, Inc. provides staff augmentation services for Information Technology and Automotive Services. Our team member benefits include:
  • Paid Holidays/Paid Time Off (PTO)
  • Medical/Dental Insurance Group
  • Accident/Critical Illness Insurance
  • Life Insurance
  • 401 (K)

About the Company

D

Datasoft Technologies

Incorporated in 1994, DataSoft Technologies, Inc. is a customer-focused consulting and staffing services organization that provides solutions across all disciplines of business, including Engineering, Finance, Information Technology, Professional, Consulting, and software development. Its staff augmentation and business solutions provide a flexible, integrated workforce available for contract to hire—or permanent placement—with companies in the private and public business sectors. The company serves a broad range of businesses in the automotive, financial services, insurance, manufacturing, media and entertainment, software and telecommunications industries.

COMPANY SIZE
20 to 49 employees
INDUSTRY
Computer/IT Services
FOUNDED
1994
WEBSITE
http://www.datasoft-tech.com

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