Are you a dedicated, adaptable, self-starter who enjoys working with and learning a wide variety of technologies? Rowan University is seeking an experienced, innovative Systems Engineer/Project Manager to join our growing community. In this position, you will work with the State’s Medicaid Fiscal Agent and related partners for the maintenance and enhancement of the NJMMIS. This includes Claims processing, member eligibility and enrollment, and the day-to-day operations of the Fiscal agent and DMAHS.
Rowan University is a Carnegie-classified Doctoral University (Moderate Research Activity) with approximately 19,000 students. Its main campus is located in Glassboro, N.J., 20 miles southeast of Philadelphia, with additional campuses in Camden and Stratford. The University comprises seven academic colleges and five schools—the William G. Rohrer College of Business; the Henry M. Rowan College of Engineering; the Colleges of Communication and Creative Arts, Education, Humanities and Social Sciences, Performing Arts, and Science and Mathematics; the Cooper Medical School of Rowan University; the Rowan University School of Osteopathic Medicine; the Graduate School of Biomedical Sciences; the School of Health Professions; and the School of Earth and Environment—with an Honors College that spans across disciplines. Rowan is one of two public universities in the country to offer M.D. and D.O. medical degree programs. The institution is also home to the South Jersey Technology Park, which fosters the translation of applied research into commercial products and processes. Rowan has been recognized as one of the top 90 public research universities and the 7th fastest growing research institution in the nation.
Plan, administer and control system’s analysis/design, and maintenance/modification activities, throughout the project life cycle for various regulatory and discretionary initiatives.
Assist the NJ Medicaid Pharmacy director in day-to day operations, and long-term planning. Assist other DMAHS Senior Staff as required.
Approve design specifications and modification results for compliance to project requirements.
Monitor and control implementation activities and assess post-implementation performance.
Drive project prioritization and monitor all on-going development activities.
Effectively manage Professional groups, Stakeholders, Trading Partner’s and Vendors/subcontractors for small, medium, and large work efforts, primarily related to Pharmacy benefits and claim’s processing.
Create and maintain system documentation, diagrams, operational procedures, architectural documentation
4-year degree or equivalent education in a related field. Professional experience may be substituted for education on a year-for-year basis.
At least 5 years of professional position related experience.
At least 10 years of experience in a State’s Medicaid Management System (MMS) with extensive knowledge of claim’s processing, member eligibility, and supporting services.
At least 7 years of experience in Pharmacy Claim’s processing, including knowledge of Pharmacy Point-of-Sale systems, Medical Exception Processing, Drug Utilization review, and Pharmacy Benefit Managers.
Knowledge of Medicaid Managed Care rules and regulations, including Capitation and Encounter processing.
Demonstrated knowledge of Federal and State drug rebate processing and rules.
At least 5 years of experience in managing medium to large scale IT projects across multiple platforms.
Good working knowledge of Client Server and Mainframe platform processing, including UNIX, Oracle and DB2 environments.
Extensive knowledge of SQL reporting in both Oracle and SQLserver.
Experience with HIPAA-compliant transactions, particularly NCPDP D.0, but also including 270/271 Eligibility Verification requests and responses.
Demonstrated experience with management of Fiscal Agents, vendors, trading partners, and other covered entities, including providers, submitters, and Medicaid Managed Care organizations.
Awareness of security industry standards and technologies.
Strength in solving technical problems and offering creative solutions.
Ability to excel when working with multi-functional teams on complex IT projects.
Solid knowledge of MS Office suite, including the ability to produce reports and work with large data sets from multiple data sources.
Excellent verbal, written and interpersonal communication skills.
Project Manager Certification (PMP designation).
Experience with other project methodologies and standards, such as Agile and CMM.
Ability to communicate technical ideas and results to non-technical clients in written and verbal form.
Ability to communicate non-technical ideas/policies to technical staff to drive requirement specifications and influence technical approach.
Knowledge of web development technology, including MS Visual Studio.
Knowledge of NJ Medicaid pharmacy policy, and member eligibility/enrollment qualifications.
Knowledge of NJ State Pharmaceutical Assistance Programs – PAAD/Senior Gold/ADDP – including its distinctive pharmacy claims processing and eligibility/enrollment rules.
Knowledge of Medicare Part D processing and general Medicare eligibility, including Coordination of Benefits and secondary claim payment rules and processing with Third-Party insurers.
Internal Number: 493896
About Rowan University
A leading public institution, Rowan University combines liberal education with professional preparation from the baccalaureate through the doctorate. Rowan provides a collaborative, learning-centered environment in which highly qualified and diverse faculty, staff, and students integrate teaching, research, scholarship, creative activity, and community service. Through intellectual, social and cultural contributions, the University enriches the lives of those in the campus community and surrounding region.