Solution Architect (MMIS / Medicaid)

We Are Hiring – Solution Architect (MMIS / Medicaid)

Remote – United States
Healthcare / Medicaid Domain

We are seeking an experienced Solution Architect with deep expertise in Medicaid Management Information Systems (MMIS) to lead the design, modernization, and implementation of enterprise healthcare solutions. This role is ideal for professionals who have a strong background in Medicaid business processes, healthcare regulations, cloud technologies, and large-scale system architecture.

Key Responsibilities

✅ Design end-to-end MMIS solutions covering:
• Eligibility Management
• Claims Processing
• Provider Management
• Payment Management

✅ Define enterprise architecture across:
• Application Layer
• Data Layer
• Integration Layer

✅ Develop scalable, modular architectures aligned with:
• MITA Framework
• CMS Guidelines
• State Medicaid Regulations

✅ Lead architecture governance, design reviews, and technical decision-making

✅ Design integrations with:
• CMS & Federal/State Systems
• Healthcare Providers & EHR/EMR Platforms
• EDI/Clearinghouse Vendors

✅ Implement interoperability standards:
• HL7
• FHIR
• X12 EDI (837, 834, 835, etc.)
• REST/SOAP APIs
• Microservices Architecture

✅ Drive MMIS modernization initiatives including:
• Legacy Transformation
• Cloud Migration
• Modular MMIS Programs
• AI & Automation Enablement

✅ Ensure compliance with:
• HIPAA
• CMS Regulations
• State Medicaid Requirements
• Security & Audit Standards

Required Qualifications

✔ 10+ years of IT experience
✔ 5+ years in Solution Architecture
✔ 5+ years supporting Healthcare or Medicaid Systems
✔ Strong MMIS or Healthcare Payer System experience
✔ Expertise in Medicaid domains:

• Claims

• Eligibility

• TPL

• Provider Management

✔ Strong experience with:

• TOGAF / Enterprise Architecture

• AWS, Azure, or GCP

• Microservices & API Design

• REST/SOAP Services

• ESB Integration Technologies

✔ Deep understanding of:

• CMS Regulations

• MITA Framework

• Healthcare Compliance Standards

Preferred Qualifications

MMIS Modernization Project Experience
Experience with COTS Medicaid Platforms:

• Conduent

• Gainwell

• Cognizant Medicaid Solutions

  Certifications:

• TOGAF

• AWS/Azure Cloud Architect

• Healthcare IT Certifications

Key Competencies

✔ Strategic Thinking
✔ Enterprise Solution Design
✔ Stakeholder Management
✔ Leadership & Mentoring
✔ Problem Solving in Complex Regulated Environments