Enterprise Architect

• Lead the architecture and integration of FIDE plan systems, including claims processing, eligibility, provider management, and reporting platforms.

• Comprehend end-to-end workflows for dual-eligible member journeys, ensuring compliance with CMS and state requirements.

• Oversee system enhancements for rate updates, retroactive claims, and encounter data submissions.

• Collaborate with cross-functional teams to identify pain points and recommend process and technology improvements.

• Ensure auditability, data integrity, and regulatory compliance across all FIDE-related systems.

• Develop and maintain architecture documentation, data flow diagrams, and integration specifications.

• Support implementation of new markets and retrofit best practices into existing FIDE programs.

Roles & Responsibilities

• Lead the architecture and integration of FIDE plan systems, including claims processing, eligibility, provider management, and reporting platforms.

• Comprehend end-to-end workflows for dual-eligible member journeys, ensuring compliance with CMS and state requirements.

• Oversee system enhancements for rate updates, retroactive claims, and encounter data submissions.

• Collaborate with cross-functional teams to identify pain points and recommend process and technology improvements.

• Ensure auditability, data integrity, and regulatory compliance across all FIDE-related systems.

• Develop and maintain architecture documentation, data flow diagrams, and integration specifications.

• Support implementation of new markets and retrofit best practices into existing FIDE programs.

Qualifications:

• Bachelor’s degree in Computer Science, Information Systems, or related field (Master’s preferred).

• 8+ years of experience in healthcare IT, with at least 1 year in Medicaid/Medicare duals or FIDE programs.

• Strong knowledge of claims, eligibility, provider, and compliance systems.

• Experience with system integration, data management, and regulatory reporting.

Generic Managerial Skills, If any

•  Collaborate with Project stakeholders and Drive the team to complete the deliverables

• Proven success working in large Medicare FDE programs 

• Expertise in solving complex business functional issues, and manage the stakeholders. 

• Team management