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Sr. Business Systems Analyst - Medicare and Health Insurance

Salem, OR
Job Title:  Sr. Business Systems Analyst - Medicare and Health Insurance
Duration: 12 months (contract) Part time 20hrs a week
Location:  Salem, OR (Hybrid/ Remote)


Key Skills: Health insurance marketplace expertise, CMS & IRS security compliance, RFP and SLA review, Analytical and problem-solving skills, Communication and interpersonal skills, Project management, Policy and standards analysis and Consolidation planning and management

Client seeks an experienced Business Systems Consultant Manager IV to serve as a “Health Insurance Exchange Transition Consultant” who will provide technical expertise and guidance during this transition. This role requires in-depth knowledge of health insurance marketplace platform capabilities, CMS (Centers for Medicare & Medicaid Services) and IRS (Internal Revenue Service) security requirements, and the ability to review and recommend improvements to Request for Proposal (RFP) requirements. 
Key Person under this WOC will provide expertise throughout the various phases of the project.

Key Person shall be responsible for:

Platform Assessment: Evaluate the existing SBM-FP policies and identify technical capabilities, limitations, and areas for improvement. Understand the nuances of the CMS Federal Data Services Hub (FDSH) integration, and transition tasks and timelines.

CMS Security Compliance: Ensure that the transition adheres to CMS security requirements, including data protection, access controls, and privacy standards.

RFP Review: Analyze RFP documents related to the transition project, identifying gaps, ambiguities, and inconsistencies. Provide recommendations to align RFP requirements with best practices.

Service Level Agreements (SLAs): Assess and suggest enhancements to SLAs, ensuring that they are clear, measurable, and align with the state's and CMS' expectations for the new SBE.

Technical Recommendations: Provide technical guidance and recommendations to enhance the state's chosen SBM platform, optimizing its efficiency, scalability, and user-friendliness.

Stakeholder Collaboration: Collaborate with state agencies, vendors, and CMS to facilitate a smooth transition process, addressing concerns and challenges effectively.

Documentation: Create comprehensive technical reports and documentation outlining the transition plan, security measures, RFP revisions, and SLA recommendations.

Required skills and experience:
 
  • Bachelor's degree in a relevant field (e.g., Computer Science, Healthcare IT, or related).
  • Extensive experience (3+ years) in health insurance marketplace platforms, preferably with exposure to SBM go-live activities.
  • In-depth knowledge of CMS & IRS security requirements and compliance standards.
  • Proven experience in reviewing and revising RFPs and SLAs for complex technical projects.
  • Strong analytical and problem-solving skills, with the ability to make data-driven   recommendations.
  • Excellent communication and interpersonal skills to work with diverse stakeholders.
  • Project management skills to ensure timely delivery of transition milestones.
  • Policy & standards analysis and implementation (7-9 years of experience)
  • Consolidation planning and management (10+years of experience)

Please Apply Online. To learn more about Mavensoft visit us at www.mavensoft.com
 

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