- Architect and optimize FIDE systems including claims, eligibility, provider management, and reporting.
- Ensure compliance with CMS and state regulations across dual-eligible member workflows.
- Manage system enhancements for rate updates, retroactive claims, and encounter submissions.
- Collaborate with business, IT, and compliance teams to improve processes and technology.
- Maintain architecture documentation, data flows, and integration specs.
- Support new market implementations and continuous improvements.
- Bachelor s degree in Computer Science, Information Systems, or related field (Master s preferred).
- 7+ years in healthcare IT; 1+ year experience with Medicaid/Medicare duals or FIDE programs.
Strong expertise in claims, eligibility, provider, compliance systems, integration, and regulatory reporting