Senior Level – Production Integration & Implementation Planning

The Senior Level – Production Integration & Implementation Planning will lead early planning activities required to transition the ClaimsCore solution from Proof of Concept (PoC) evaluation toward a scalable production implementation.  You will work across Peraton, CMS, MACs, Cognizant and other technology partners to develop the integrated implementation approach for production, with initial emphasis on Tier 1 interface integration, MAC integration and transition planning, production implementation sequencing, cost modeling, dependency identification, resource requirements, and operational readiness.  You will translate lessons learned and technical evidence from the ClaimsCore PoC into an executable production implementation strategy and will be a key contributor to the Production Integrated Master Plan and Schedule (IMPS), Total Cost of Ownership (TCO) analysis, integration planning, MAC transition planning, and other pre-production planning deliverables.  The position requires someone capable of operating at both the strategic and execution levels—understanding complex healthcare claims environments while converting technical, operational and stakeholder requirements into a realistic production roadmap.

Primary Responsibilities

• Lead development of the ClaimsCore production implementation strategy and roadmap, incorporating PoC findings, CMS requirements, technical dependencies, operational constraints, and lessons learned.
• Lead planning of Tier 1 interfaces: I/F inventory, ownership, dependencies, specifications, connectivity, testing, certification, implementation sequencing and production readiness.
• Develop the overall MAC integration and transition planning framework, outline the steps to onboard and transition MACs into the future ClaimsCore operating environment.
• Work with CMS and MAC stakeholders to identify current-state interfaces, dependencies, data exchanges, business processes, transition constraints and readiness requirements.
• Support development of the Production IMPS, including workstreams, critical path, dependencies, staffing assumptions, stage gates, entry/exit criteria, implementation waves and risks.
• Develop implementation sequencing recommendations for moving from PoC capabilities through parity, production readiness, MAC onboarding, deployment and stabilization.
• Coordinate with Data Migration team to incorporate historical data migration, reconciliation, data validation and MAC-specific data transition activities into the production roadmap.
• Coordinate with Claims Accuracy & Business Rules team on business-rule migration, configuration, regression testing, claims parity and validation activities into production planning.
• Coordinate with Tech Ops & Security to detail cloud infrastructure, environments, security authorization, performance, disaster recovery, monitoring and operational readiness activities.
• Coordinate with Change Management to incorporate MAC stakeholder engagement, communications, training, organizational readiness and cutover preparation.
• Support development of the five-year Total Cost of Ownership model, including implementation costs, infrastructure/cloud costs, licensing, labor, integration, migration, operations/support, MAC transition costs and other major cost drivers.
• Identify production implementation assumptions and develop low/base/high or alternative implementation scenarios where appropriate.
• Support development of program staffing and resource models, for stakeholders including Peraton, Cognizant, CMS and the MACs.
• Facilitate cross-workstream production planning sessions and ensure assumptions, dependencies and decisions are captured and incorporated into the integrated plan.
• Identify implementation risks early and develop recommended mitigation strategies.

Required Qualifications

• Minimum of 12 years with BS/BA; or 10 years with a MA/MS degree. 

• TriZetto Facets or comparable enterprise claims-adjudication platform experience.
• Demonstrated experience planning or executing complex production implementations involving multiple systems, interfaces and stakeholder organizations.
• Strong experience with healthcare payer or government claims-processing environments.
• Experience with enterprise systems integration, interface planning and implementation.
• Experience developing integrated implementation plans, roadmaps, schedules and dependency models.
• Experience coordinating technical, data, operational and business workstreams.
• Experience developing or contributing to implementation cost estimates, TCO models or business cases.
• Demonstrated ability to work directly with senior government/customer stakeholders and technology partners.
• Strong executive communication, facilitation and planning skills.
• Ability to obtain a Public Trust. 

Highly Preferred Qualifications

• 12+ years of experience managing large-scale healthcare, claims-processing, systems integration, or enterprise modernization programs.
• Medicare Fee-for-Service or CMS claims-processing experience.
• MAC operational or systems integration experience.
• Experience with X12 healthcare transactions, including 837/835 and related healthcare interfaces.
• Experience with claims-system data migration and business-rule conversion.
• Knowledge of CMS’ Healthcare Integrated General Ledger Accounting System (HIGLAS)
• AWS/hybrid-cloud modernization experience.
• Experience transitioning large government systems from pilot/PoC through production.
• PMI PMP Certification
• SAFe/Agile experience in large multi-team programs.