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Position: SME System Consultant

Location: Remote

Duration: 12 months

Who we are:

Cloud and Things is building a platform to allow you to build your career! Our goal is to solve problems and deliver results for our clients. At Cloud and Things, you can be a part of the transformation of the public sector's IT environment. Our team is on the forefront of helping to solve the government's most complex IT challenges. If you are seeking a role that offers you the opportunity to work on rewarding projects, consider a career with Cloud and Things.

Overview:

We are seeking a Claims SME/ Medicaid Systems Consultant to join our team. This is a part-time or full-time position that will support the State of Connecticut project. The successful candidate will be responsible for understanding how claims processing works in MMIS, including prior AUTH's, COB, adjudications, etc., and be able to help the client document current processing and prepare for an eventual claim's module replacement. Additionally, the candidate will be responsible for reviewing the client's care and case management systems, performing an assessment of the current systems, identifying technical requirements, and assisting the team and state of CT in writing a proposal for upgrading these two systems.

Key Responsibilities:

• Understand how claims processing works in MMIS, including prior AUTH's, COB, adjudications, etc.
• Help the client document current processing and prepare for an eventual claims module replacement.
• Review the client's care and case management systems.
• Perform an assessment of the current systems.
• Identify technical requirements for upgrading these two systems.
• Assist the team and state of CT in writing a proposal for upgrading these two systems.

Mandatory Qualifications:

• Bachelor's degree in Computer Science, Information Systems, or a related field.
• Minimum of 5 years of experience as a Claims SME or Medicaid Systems Consultant.
• Experience with MMIS and claims processing.
• Strong understanding of care and case management systems.
• Ability to assess and identify technical requirements for system upgrades.
• Excellent verbal and written communication skills.
• Ability to work independently and collaboratively with a team.
• Strong problem-solving and analytical skills.

Preferred Qualifications:

• Master's degree in Computer Science, Information Systems, or a related field.
• Experience working with Medicaid systems and regulations.
• Knowledge of healthcare payment policies and procedures.
• Experience with project management and proposal writing.

Cloud and Things complies with all applicable federal, state, and local laws regarding recruitment and hiring. All qualified applicants are considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or any other category protected by applicable federal, state, or local laws.