Client Solutions Manager-Medicaid

Abacus Insights is a mission-driven technology company focused on transforming the healthcare data industry, ultimately creating a more personalized patient experience, improving health outcomes, and lowering the overall cost of healthcare. Abacus Insights provides a flexible, efficient, and secure platform that organizes and exchanges healthcare data from various sources and formats, allowing our customers to uncover differentiated insights. In addition, our employees know that they play an active role in keeping our customers' data safe and are responsible for ensuring that our comprehensive policies and practices are met.

With our deep expertise in cloud-enabled technologies and knowledge of the healthcare industry, we have built an innovative data integration and management platform that allows healthcare payers access to data that has been historically siloed and inaccessible. Through our platform, these healthcare organizations can ingest and manage all the data they need to transform their business by supporting their analytical, operational, and financial needs.

Since our founding in 2017, Abacus has built a highly successful SaaS business, raising more than $81 Million from leading VC firms with deep expertise in the healthcare and technology industries. We are solving problems of massive scale and complexity in a sector that is not only ready for disruption. We're growing quickly and would love for you to be a part of it!

About the Role:

We are seeking an experienced professional with operational and business analysis experience in healthcare quality operations, and related data, to join our client solutions team. The successful candidate will lead the requirements gathering, analysis and definition for solutions to support payer clients in the following areas:

• Expertise in the Medicaid regulations and best practices
• Understand how MCOs operate, including member management, cost management, quality of care, provider management and care management (including home health programs)
• Understand health equity and methods used by plans to eliminate disparities and improve health outcomes
• Understand Quality Measures
• Understand HEDIS measures and interpreting their impact
• CMS data sources
• Operational processes supporting the aforementioned areas

This role requires an analytical thinker with experience in Medicaid healthcare operations, understanding of quality, risk, and financial data domains, and understanding related CMS data, with a focus on Medicaid. The Client Solutions Manager must have a proven track record in leading the development of business requirements in a client-based setting. Qualities required to succeed in this role include understanding the risk and quality data domains, strong cross-functional collaboration skills, and exceptional client engagement acumen.

Within the quality data space you will:

• Client Solutions Requirements Management: Develop business requirements in the form of use cases that capture the client’s requirements. Work with client’s designated subject matter expert to understand business requirements and gather into a Business Requirements Document (BRD). This may include elaborating on requirements with the client, capturing acceptance criteria, and identifying non-functional requirements. Requirements scope can vary across a broad range of client deliverables including reports, dashboards, data extracts or views into the data used by the client for operations or analytics.
• Operational Expertise: Use your operational experience and knowledge of Medicaid operations and healthcare data to triage business requests and requirements.
• Requirements Validation: Perform a set of tests against the delivered solution and confirm all acceptance criteria are met before turning over the solution to the client. This is a validation step performed by the author of the business requirements with assistance from other team members to simulate the actual client user acceptance testing (UAT) as a precursor to the client’s actual UAT. This activity compliments core testing performed by the Abacus QA team.
• User Acceptance Testing: Laise with the client and partner with team members to coordinate and progress the client’s UAT.
• Customer Relationship Management: Partner with Account Management, Program Management, Sales, and Product Management to develop strong customer relationships, resulting in reference customers.
• Collaboration and Coordination: Work closely with cross-functional teams, including business experts, technical business analysts, project managers, account executives and data engineers to successfully implement client projects. Collaborate with Product Management to identify client-specific requirements that may translate into an existing standard product feature or a future feature on the product roadmap.
• Training and Support: Provide training to internal teams on business needs and use cases for seamless client implementation. Provide ongoing support to address questions and issues raised by the implementation team.
• Cross-Functional Communication: Serve as a bridge between the client and Abacus technical teams, effectively communicating business requirements to team members.
• Change Management: Own and manage all net new requests from client, tracking resolution using internal project management tool.
• Awareness of Product Capabilities: Become educated and understand the strategy of new product launches, new features, and product upgrades, and how they support the client.
• Process Improvement: Conduct process analysis, process evaluation, and implement process improvements that lead to better solutions and client satisfaction.

What we’re looking for:

• Bachelor’s degree in Health Care Administration, Computer Science, Business, Analytics, or equivalent experience.
• 5+ years operational experience in quality management programs with a focus on Medicaid processes. Minimum 2+ years' experience in HEDIS, Stars or quality related work. Strong working knowledge of US healthcare data, including but not limited to Medical Claims, Pharmacy Claims, Eligibility, Plan, Enrollment, Clinical, and Provider.
• Strong understanding of healthcare industry trends, Medicaid regulations, and customer needs with preference for previous payer operational experience.
• Demonstrated success driving client-facing conversations and navigating payer organizations to identify requirements.
• Business domain expertise and associated technical proficiency to deliver solutions that meet the client’s needs within healthcare quality data domain.
• Demonstrated experience navigating complex Payer and Payvider environments as an analyst or a consultant eliciting a client’s business requirement and building relationships.
• Strong communicator who can leverage their domain expertise effectively with the client and build working relationships with internal and external team members. Ability to communicate succinctly and clearly, both verbally and written, across technical and non-technical audiences at multiple levels.
• Analytical thinker with the ability to understand and document business processes; elicit and identify implied requirements, extract insights, and translate them into comprehensive and cohesive requirements and requirement plans.
• Ability to de-escalate customer complaints.
• A high level of project organization, attention to detail, and time management.
• "Roll up your sleeves mentality" working side-by-side with your team.
• Demonstrated ability to thrive in a fast-paced, dynamic startup environment.

The ideal candidate will be organized, self-motivated, and able to complete complex tasks with little supervision. The Client Solutions Manager will be encouraged to remain current with market trends by participating in educational opportunities, reading professional publications, maintaining personal networks, and participating in professional organizations. This individual will be required to work with internal and external departments and able to position products, solutions, and services to be highly competitive to address market and client needs.

Equal Opportunity Employer

As a mission-led technology company that is helping to drive better healthcare outcomes, Abacus Insights believes that the best innovation and value we can bring to our customers comes from diverse ideas, thoughts, experiences, and perspectives. We are dedicated to building diverse teams and providing equal employment opportunities to all applicants. Abacus prohibits discrimination and harassment of any type in regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.