Medicaid Subject Matter Expert

Medicaid Subject Matter Expert - #5994 Jackson, MS | On-Site | Contract Key Responsibilities • Serve as the authoritative expert on Medicaid program data, policies, and operational workflows to support the successful deployment and operationalization of the Program Integrity (PI) tool. • Collaborate effectively with technical teams, program staff, vendors, and project leadership to ensure the PI solution accurately leverages Medicaid data for fraud detection, waste prevention, and abuse investigation. • Provide comprehensive guidance on Medicaid data domains, including member eligibility, demographic details, managed care enrollment, provider credentials, and claims processing. • Lead data mapping, data model validation, and quality assessments, identifying issues and developing remediation strategies to ensure data integrity and compliance with federal and state regulations. • Support the creation of analytics, business rules, and investigative workflows tailored to Medicaid fraud, waste, and abuse detection needs. • Assist with system implementation activities, including data validation, testing, and stakeholder reviews, to guarantee accuracy and relevant system outputs. • Facilitate communication among stakeholders, including program leaders, analytics teams, IT, and vendor partners, to align project goals and ensure successful system rollout. • Contribute to documentation efforts such as data dictionaries, use cases, and validation reports, supporting user acceptance testing and system configuration validation. Qualifications • At least 15 years of experience working with Medicaid program data and operational workflows. • Deep expertise in core Medicaid data domains: member eligibility, provider enrollment, claims, encounter data, and managed care systems. • Proven experience working with Gainwell Medicaid Management Information Systems (MMIS) or similar platforms. • Strong understanding of Medicaid policies, federal regulations, and CMS reporting standards. • Extensive experience supporting large-scale system implementations or modernization projects within Medicaid or government health programs. • Excellent communication skills, capable of translating complex Medicaid data and policies for technical and non-technical audiences. Preferred Qualifications • Hands-on experience implementing Provider Enrollment systems. • Proven success in deploying claims management systems and managing claims data. • Familiarity with CMS compliance standards, reporting requirements, and audit processes. About Delphi-US - Peacemakers In The Talent War Delphi-US is a national IT Services firm based in Newport, Rhode Island. Delphi attracts our nation’s best and brightest Technical & Professional Talent and positions our nation’s finest employers to further their competitive advantages. Delphi's core technical focus includes Data Sciences & Analytics, Modern AI/ML Model Monetization, Cloud Engineering, Cyber Security, ERP Rescue; serving domains from sensitive national energy sectors to critical financial services, biomed, life sciences & pharma, major government & municipal institutions, and much of the USA's Fortune 500 corporations. Delphi Associates are deployed on critical IT Projects where their consultative business acumen, comprehensive technical expertise, and committed service mission drives our client’s success. Our proprietary skill-based and cultural matching process results in higher qualified project teams, custom curated for our client’s specific technical & functional goals. We are supremely experienced, friendly, professional, and ready to advocate on your behalf. Delphi has an indelible understanding of employer expectations, a track record of project success, and we deliver lasting results.