Medicare - Chief Information Officer

Job Description: The Medicare Chief Information Officer (CIO) serves as the lead person responsible for the total technology functions within a Medicare Administrative Contractor (MAC) operations covering a government-specified multi-state jurisdiction.  The MAC will include both Part A and Part B operations.  The technology functions include maintaining telecommunication protocols and lines, software and hardware for sending and receiving EDI and EFT; supporting direct data entry for providers; actively participating in and supporting the CMS change management process and making system changes as required; maintaining integrity of all systems interfaces; providing comprehensive systems testing for all interfaces; interacting with the standard system maintainers and the Enterprise Data Center; participating in weekly technical advisory calls with CMS; working with the MAC Claims Processing Manager regarding claims processing problems; ensuring HIPAA compliance and other system security controls; providing telephone systems and service; systems risk management; transition planning & implementation.  The CIO will supervise staff to carry out the work required for the above functions.

 

The CIO shall be responsible for certifying compliance with Centers for Medicare & Medicaid Services (CMS) systems security requirements.  The CIO may oversee other Medicare Contracts, not just the A/B MAC, but must be dedicated to Medicare-only business lines of work.

 

Reports to MAC Chief Operating Officer

 

 

Basic Requirements:

The Chief Information Officer (CIO) shall have at least ten years of experience working in large organizations with significant managerial or other practical involvement relating to IT management, and possess knowledge of and extensive practical experience in information technology (IT) practices, including security controls. 

 

Preferred Work Experience:Prior experience in systems support for Medicare Part A (intermediary) and Part B (carrier) claims processing operations. Participation in a government-contract workload transition between claims processing contractors.

 

Education:  An information technology degree from an accredited four-year college or graduate program or equivalent experience, preferably as a CIO.

 

New Contract Award Transition Responsibilities: 

ACS may compete for MAC awards in various jurisdictions.  Following award of a new MAC contract, the incoming contractor will lead efforts to establish system connectivity with the incumbent data centers, the CMS Enterprise Data Center (EDC), and other Medicare contractors; support providers ability to submit claims electronically; ensure MAC system integrity and security; and establish all necessary interfaces for interaction with specialty Medicare contractors.

The CIO will also be responsible forDevelopment and implementation of various transition plans (e.g.risk management plan, segment cutover plan, and comprehensive system testing plans) during the transition phases of the new program..  Consolidate the existing shared system edits of the outgoing contractors so that they are the same for the entire jurisdiction.  Provide infrastructure required, to integrate and interact with the assigned CMS Enterprise Data Center (EDC) and to accomplish services not provided by the EDC, to fulfill the requirements of the MAC contract.  Assist with migration from existing incumbent data centers to the new EDC..Provide or acquire CMS-required hardware and software.Acquire and maintain telecommunication protocols and lines, and software and hardware necessary to send and receive electronic transactions through EDI, as well as electronic funds transfers to providers.