SME
Datasoft TechnologiesJackson, MS
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Overview
Remote
On-site
Job Description
SME Onsite: Jackson, MSAbout the Job
- Duration: Long term Contract Position
- Location: Onsite: Jackson, MS
- Pay rate: Hourly
- Job ID: 156120
- Data Domain Expertise
- • Medicaid Member Data (eligibility, enrollment, demographics, coverage)
- • Managed care enrollment and attribution
- • Member identifiers and cross-system matching
- • Provider enrollment and credentialing
- • Provider taxonomy and specialty classifications
- • Provider affiliations and group relationships
- • National Provider Identifier (NPI) integration
- • Professional, institutional and pharmacy claims
- • Claim lifecycle and adjudication
- • Service codes (CPT, HCPCS, ICD, DRG)
- • Payment and encounter processing
- • Claim adjustments and resubmissions
- • MCO encounter data
- • Capitation payments
- • Managed care reporting
- • Encounter-to-claim validation
- • 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
- • 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
- • Program Integrity leadership
- • Data analytics teams
- • Medicaid staff
- • IT architecture teams
- • Implementation vendors
- • Managed care oversight teams
- • Data domain documentation validation
- • Data dictionary validation
- • Business rule validation
- • Data quality reports
- • System configuration documentation
- • UAT validation reports.
- 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.
- Provider enrollment systems
- Claims systems
- CMS reporting compliance.
- Paid Holidays/Paid Time Off (PTO)
- Medical/Dental Insurance Group
- Accident/Critical Illness Insurance
- Life Insurance
- 401 (K)
Automate your job search with Sonara.
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FAQs About SME Jobs at Datasoft Technologies
What is the work location for this position at Datasoft Technologies?
This job at Datasoft Technologies is located in Jackson, MS, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.
What pay range can candidates expect for this role at Datasoft Technologies?
Employer has not shared pay details for this role.
What employment applies to this position at Datasoft Technologies?
The employer has not provided this information. This may be discussed during the hiring process.
What is the process to apply for this position at Datasoft Technologies?
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