Job Description

Job Title: MMIS IV&V Specialist

Location: Hybrid- Augusta, Maine

Duration: Full-time with Apexon

Here is the role we are looking for right now. It’s a sold, funded position. It is for a more technical person to work on MMIS IV&V engagement. Role can start ASAP.

What You Will Do:

We are seeking a MMIS IV&V Specialist with deep knowledge of Medicaid enterprise systems, particularly Medicaid Management Information Systems (MMIS) and related implementations. This individual will work directly with state agencies, system integrators, and internal teams to independently assess the quality, alignment, and risks associated with MMIS design, development, and implementation.

The successful candidate will:

• Independently assess and interpret MMIS-related technical documentation (e.g., system design documents, interface control documents, configuration documents, and traceability matrices), ensuring completeness, consistency, and alignment with Medicaid program needs.
• Participate in MMIS system design reviews and technical discussions, offering critical insights based on a deep understanding of Medicaid systems, architecture, and common risk patterns.
• Evaluate requirements traceability, ensuring technical and functional requirements are accurately linked to design, development, testing, and deployment artifacts.
• Support testing lifecycle assessments, including review of system integration testing, user acceptance testing (UAT), and end-to-end testing strategies and execution. Identify gaps and prioritize concerns based on risk, coverage, and readiness.
• Contribute to data conversion and migration assessments, including evaluation of mapping, cleansing, and validation activities across key modules such as provider, member, claims, and prior authorization.
• Translate complex technical and system implementation issues into documented actionable insights for diverse stakeholders ranging from Medicaid program staff to system vendors and internal leadership.
• Understand CMS guidelines, federal and state compliance standards, and how they should be reflected in Medicaid system design and deployment.
• Collaborate with state agencies (including Medicaid, Behavioral Health, Intellectual and Developmental Disabilities, State Units on Aging, and/or Social/Human Services) to support system modernization and business transformation efforts.
• Manage discrete projects or task areas, contribute to client deliverables, and support ongoing engagement execution.
• Provide subject matter expertise, as requested and appropriate

What You Will Need:

• A bachelor’s degree in business administration (finance or accounting), computer information systems, economics, health policy and administration, public policy, public health, social service administration, or similar focus
• 7–10 years of experience supporting large-scale healthcare IT programs, including at least 3+ years supporting Medicaid MMIS implementations.
• Strong understanding of Medicaid system components, including eligibility, claims processing, provider enrollment, member management, prior authorization, and other modular functions.
• Familiarity with Medicaid regulations, CMS guidelines, and state compliance requirements.
• Demonstrated ability to critically assess system documentation and implementation approaches with minimal supervision.
• Strong analytical and writing skills, including experience developing and delivering client-ready technical assessments and findings.
• Ability to travel to meet client needs (10-30%) as required

What Would Be Nice to Have:

• Experience performing IV&V on Medicaid systems
• Direct experience working with or reviewing the work of system integrators such as Gainwell, or other MMIS vendors.
• Knowledge of state health agencies and healthcare reform, e.g., Medicaid, public health, health insurance, and health reform organizations (legislative, executive, governor’s office)
• A master’s degree in an IT, business, or health-related field
• Superior written and oral communication skills
• A strategic problem solver
• Demonstrated ability to self-manage task execution and manage discrete task / project / initiative functions.
• The ability to work overtime as necessary
• Assure high-quality client-ready work product

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