Director, Medicaid Tech Svcs
Fidelis Care - Amherst, NY

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Job Summary

The Director of Medicaid Technical Servces role provides leadership and is responsible for partnering with FCNY Senior and Executive management to support compliance with new and existing Medicaid product initiatives and NYS DOH mandates and audits for the Mediciad, Family Health Plus, Child Health Plus, and LTC products. This position acts as the single point of contact liaison with FCNY business sponsors, external State regulatory contacts, external vendors, and provides oversight to new initiatives requiring coordination with State program representatives. Manages the Medicaid Product Oversight team of Sr. Analysts and Project Managers providing business process management support, customer relationship management, and strategic and tactical guidance for all Medicaid initiatives, thus ensuring compliance with NYS DOH mandates and corporate strategic alignment. Provides Cross-functional Medicaid product oversight acting as the “filter”/checkpoint for all business process support across Core Applications teams; EDI, CCD and Facets. Oversight of the Medicaid line of business assumes EDI, CCD and Facets managers have dotted line accountability to the Medicaid and Product Oversight Manager including IT request management and assignment, production issue management and resolution, maintenance, Discretionary and Strategic initiatives, and Annual Recurring projects. Ensure compliance with all NYS DOH regulations and guidelines across all Medicaid related programs, processes and procedures.

The Director of Medicaid Technical Services is responsible for driving strategic planning efforts for both new and recurring initiatives requiring IT support. This position provides oversight and support for recurring program examples such as NYS DOH Audits, QARR, CRG Medical Records review, MLTC product oversight partnering with the Medicare Product Oversight Manager, MMCOR, NYS Medicaid and CHP mandates, to ensure FCNY maintains alignment with all mandated strategic and discretionary reporting.


8 plus years Medicaid experience working in regulatory relations support role.

8 plus years Program Management.

Knowledge of the payment and the support claims payment to include provider relations.

Ability to investigate new technologies to further data support of business and implement innovative methods of support and service.

Understanding of current Medicaid initiatives and mandates to support business strategies and ensure that application systems are configured.

Knowledge Of Medicaid rate and business rules and changes in products and business rules.

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From its origin in 1993 as the Catholic Health Services Plan of Brooklyn and Queens, Inc., Fidelis Care has grown -- both in the scope of...