Solution Architect with Healthcare
Posted 2 weeks ago by Spar Information Systems
Negotiable
Undetermined
Remote
Remote
Summary: The Solution Architect role focuses on designing and implementing end-to-end Medicaid Management Information Systems (MMIS) solutions, ensuring compliance with CMS guidelines and state regulations. The position requires strong technical leadership, integration design, and stakeholder collaboration to modernize healthcare systems. The architect will also oversee data architecture and analytics, ensuring robust security and compliance. This role is primarily remote but may require occasional client site visits.
Key Responsibilities:
- Design end-to-end MMIS solutions, including eligibility, claims processing, provider management, and payment modules.
- Define system architecture across application, data, and integration layers.
- Develop scalable, modular, and interoperable system designs aligned with MITA framework.
- Ensure solutions align with CMS guidelines and state Medicaid regulations.
- Provide architectural guidance to development, integration, and QA teams.
- Review and approve technical designs, code, and configurations.
- Lead architecture governance and design reviews.
- Mentor technical teams on best practices and emerging technologies.
- Design integrations with Federal and State systems, third-party vendors, and healthcare systems.
- Ensure adherence to interoperability standards such as HL7/FHIR and X12.
- Define data architecture including data flows, storage, and governance.
- Ensure support for reporting, analytics, and regulatory compliance.
- Oversee data migration and modernization initiatives.
- Ensure solutions comply with HIPAA, CMS Medicaid guidelines, and state-specific requirements.
- Implement robust security, privacy, and audit controls.
- Lead MMIS modernization initiatives and evaluate emerging technologies.
- Collaborate with business stakeholders, program managers, state Medicaid agencies, and vendors.
- Translate business requirements into technical architecture.
Key Skills:
- Bachelor's or Master's degree in Computer Science, Information Systems, or related field.
- 10+ years of IT experience with at least 5+ years in solution architecture and 5+ years in healthcare or Medicaid systems.
- Proven experience working on MMIS or large healthcare payer systems.
- Strong experience in enterprise architecture frameworks (TOGAF preferred), cloud platforms (Azure/AWS/Google Cloud Platform), microservices, and API design.
- Knowledge of Medicaid domains, EDI X12 transactions, and HL7/FHIR.
- Deep understanding of Medicaid business processes, CMS regulations, and healthcare compliance standards.
- Experience with MMIS modernization projects and knowledge of COTS Medicaid platforms.
- Certification in TOGAF / Cloud Architect (Azure/AWS) and healthcare IT standards.
- Strategic thinking, problem-solving, strong communication, and stakeholder management skills.
- Leadership and mentoring abilities, with the capacity to work in complex, regulated environments.
Salary (Rate): undetermined
City: undetermined
Country: United States
Working Arrangements: remote
IR35 Status: undetermined
Seniority Level: undetermined
Industry: IT
Hello;
Job Title: Solution Architect
Job Location & Mode: United States, Remote, Willing to go to client site on a need basis
Long Term
Key Responsibilities
1. Solution Architecture & Design
Design end-to-end MMIS solutions, including eligibility, claims processing, provider
management, and payment modules.
Define system architecture across application, data, and integration layers.
Develop scalable, modular, and interoperable system designs aligned with MITA (Medicaid
Information Technology Architecture) framework.
Ensure solutions align with CMS guidelines and state Medicaid regulations.
2. Technical Leadership
Provide architectural guidance to development, integration, and QA teams.
Review and approve technical designs, code, and configurations.
Lead architecture governance and design reviews.
Mentor technical teams on best practices and emerging technologies.
3. Integration & Interoperability
Design integrations with:
o Federal and State systems (CMS, HHS)
o Third-party vendors (EDI, clearinghouses)
o Healthcare systems (EHR/EMR)
Ensure adherence to interoperability standards such as:
o HL7 / FHIR
o X12 (EDI transactions)
o APIs and microservices architecture
4. Data & Analytics
Define data architecture including data flows, storage, and governance.
Ensure support for reporting, analytics, and regulatory compliance.
Oversee data migration and modernization initiatives.
5. Compliance & Security
Ensure solutions comply with:
o HIPAA
o CMS Medicaid guidelines
o State-specific requirements
Implement robust security, privacy, and audit controls.
6. Modernization & Transformation
Lead MMIS modernization initiatives (legacy transformation to cloud/microservices).
Evaluate and adopt emerging technologies (AI/automation, cloud-native design).
Support modular MMIS initiatives.
7. Stakeholder Management
Collaborate with:
o Business stakeholders
o Program managers
o State Medicaid agencies
o Vendors and implementation partners
Translate business requirements into technical architecture.
Required Qualifications
Education
Bachelor's or Master's degree in Computer Science, Information Systems, or related field
Experience
10+ years of IT experience with at least:
o 5+ years in solution architecture
o 5+ years in healthcare or Medicaid systems
Proven experience working on MMIS or large healthcare payer systems
Technical Skills
Strong experience in:
o Enterprise architecture frameworks (TOGAF preferred)
o Cloud platforms (Azure/AWS/Google Cloud Platform)
o Microservices and API design
o Integration technologies (ESB, REST/SOAP)
Knowledge of:
o Medicaid domains (Claims, Eligibility, TPL, Provider Mgmt)
o EDI X12 transactions (837, 834, 835, etc.)
o HL7/FHIR
Domain Knowledge
Deep understanding of:
o Medicaid business processes
o CMS regulations and MITA framework
o Healthcare compliance standards
Preferred Skills
Experience with MMIS modernization projects
Knowledge of COTS Medicaid platforms (e.g., Conduent, Gainwell, Cognizant solutions)
Certification in:
o TOGAF / Cloud Architect (Azure/AWS)
o Healthcare IT standards
Key Competencies
Strategic thinking and problem-solving
Strong communication and stakeholder management
Leadership and mentoring
Ability to work in complex, regulated environments
Success Metrics
Successful delivery of MMIS architecture solutions
Compliance adherence (zero audit issues)
System scalability, uptime, and performance
Stakeholder satisfaction