Solution Architect

Job Title: Solution Architect

Job Location & Mode: Remote, Willing to go to client site on a need basis

Duration: 6+ months

Role Overview

The Solution Architect is responsible for designing, implementing, and optimizing enterprise-level solutions for Medicaid Management Information Systems. This role ensures alignment of technology architecture with Medicaid business processes, federal/state regulations, and industry standards, enabling scalable, secure, and compliant healthcare solutions.

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