Medicaid Business Subject Matter Expert (SME)
Waterbury
Immediate long-term contract opportunity for Medicaid Business Subject Matter Expert with direct client in Waterbury, VT. Trigyn Technologies is seeking a highly experienced Medicaid Business Subject Matter Expert (SME). This role provides deep Medicaid business, operational, and policy expertise across payment reform initiatives and Medicaid Management Information System (MMIS) modernization. The SME will help translate business needs into actionable requirements, support system validation, and ensure programs and modernized solutions align with federal and state policy. Role Overview: The SME will split time between two major workstreams: 1. Medicaid Payment & Care Delivery Reform (Primary Focus Area) The role will provide business and analytic support to client’s Payment and Care Delivery System Reform program. This includes: • Supporting alternative payment models, value-based purchasing, and Medicaid rate-setting efforts. • Collaborating with business units to coordinate program activities and synthesize communications. • Conducting research and preparing recommendations, business documentation, and stakeholder-ready materials. • Keeping program documentation organized and updated as new initiatives progress. 2. MMIS Business Operations & Modernization The SME will provide business and policy expertise across key MMIS domains, including: • Claims processing • Provider enrollment • Prior authorization • Pharmacy benefit management • Care management • Appeals and TPL • Eligibility & enrollment coordination • HIE data exchange considerations Key Responsibilities • Provide deep subject matter expertise in Medicaid business processes, operational workflows, and program policies. • Develop and refine business requirements, workflows, business rules, and policy documentation supporting modernization initiatives. • Assess operational impacts of system or process changes and recommend mitigation strategies for seamless implementation. • Serve as a liaison between business teams and technology teams to ensure solutions meet real-world operational needs. • Support validation activities to ensure requirements and policy objectives are met. • Advise on compliance with federal and state Medicaid regulations. • Identify risks, track milestones, and help measure success of modernization efforts. • Mentor State staff and support knowledge transfer to build long-term program capability. • Support creation of presentations, reports, and materials for internal and external stakeholders. Qualifications & Experience • Bachelor’s degree in a relevant field (public health, public policy, healthcare administration, business, IT) or equivalent experience. • Extensive experience in a state Medicaid program, healthcare payer, or similar health policy environment. • Strong understanding of Medicaid operations, policy, and business domains. • Experience with MMIS, Medicaid Enterprise Systems, or system modernization efforts strongly preferred. • Familiarity with payment reform models, value-based payment methodologies, or rate-setting (preferred). • Proven ability to translate complex policy and operational requirements into business rules and process documentation. • Excellent communication, stakeholder engagement, analytical, and documentation skills. • Ability to work onsite in Waterbury, VT, on a hybrid basis, at the request of the State. TRIGYN IS AN EQUAL OPPORTUNITY EMPLOYER About Trigyn: Trigyn is an IT Services Company that has been in business for 30 years with more than 1,500 resources deployed today. Trigyn is ISO 9001:2015, ISO 27001:2013 (ISMS) and CMMI Level 5 Certified. Trigyn is an E-Verify® Employer. Apply