Business Architect project
Business Architect project for the state- Must have worked Medicaid & State Government exp is Mandatory.
Job Description
Scope Overview
The scope of services under this Task Order will include KPMG s assistance in documenting, based on DOH s input, a future state business architecture describing how OHIP would like to operate as a result of the broader MES modernization effort. The scope of services under this Task Order includes the development of a business architecture plan that clearly articulates the OHIP business areas in scope and aligns this plan with the larger Enterprise Architecture Management Plan (F11) regarding the sequence of business areas in focus.
Additionally, the scope under this Task Order includes activities focused on providing DOH with an enterprise capability model able to support the desired future state as well as a high-level enterprise operating model supporting the OHIP desired future state.
Furthermore, for each of the business areas in scope, the scope of services under this Task Order will include:
- the documentation of stakeholders and interactions aligned with the respective area (Context Models),
- a compendium of pain points witnessed in current operations and
- the development of optimized future state workflows to support the larger program vision and goals.
Specifically, KPMG will conduct the following activities:
1. Define the scope of this effort regarding both MITA and non-MITA business areas (e.g., NYSOH functions such as customer service and premium billing, including identifying which parts of the business will be included and the extent to which they will need to be included in the business architecture. Initial expectations for business areas to cover include:
Provider management
Business relationship management
Care & Case management
Eligibility & Enrollment (MAGI, Complex Medicaid, APTC)
Member management
Operations management (claims, pharmacy, etc.)
Financial management
Plan management (MCOs)
Performance Management
Contractor management
Customer service
SHOP
Premium payment
2. The KPMG TAS team will review the progress that was made by the initial business architecture proof of concept team, including any standards that were established and agreed upon for documenting business process workflows. KPMG will provide recommendations to DOH regarding revisions based on industry standard architecture practices.
3. Identify dependencies (content and timing) that procurements have on each business areas and each process group with each other to understand priorities, relationships, and sequencing.
4. Develop a plan for how the business architecture effort aligns with the MES Roadmap, and the sequence in which business area documentation will be completed.
5. Establish business owners for each business area identified and establish an enterprise business working group for high level discussions, and more detailed working groups for each business area.
6. Transition relevant KERA reference content from KPMG Sparx tool into the DOH environment and tool of choice (iServer). This transition will be addressed business area by business area as part of the respective business area planning scope and activities.
7. Establish an enterprise-wide capability model that can be used to provide overall context to how OHIP business process areas will operate and review through enterprise level workshops. This will be expedited by the KERA HHS / Medicaid capability models and updates made through the MECM procurement business architecture definition.
8. Conduct detailed workshops for each business area that will review draft content and identify changes. Draft content will leverage KERA reference model business process workflows and business context models (that incorporate MITA requirements).
9. We will begin each business area assuming a 6-week timeline but will scale up or down for each area based on its complexity and the availability of DOH subject matter experts.
10. Each business area will follow a similar pattern for documenting its target business architecture:
Identify the scope of the business area, including discussions on the workflows that should be included in that area.
Review goals / objectives and KPIs for each area and the key pain points that exist in the current state that are targeted for improvement. No current state business process workflows are expected to be developed.
Each business area will include at least one context model describing high level business interactions and a workshop to review drafts and make updates
Map out the high-level business process workflows in scope and plan workshops with appropriate NYS staff according to the number and complexity of these workflows.
Facilitate workshops with DOH staff and relevant stakeholders to review and validate business architecture artifacts.
Identify high-level expectations for future automation of business process workflows, that can be used as a starting point for future requirements discussions.
Document the future state business architecture for each business area as a section in the overall deliverable. Each section will be reviewed individually by the DOH team supporting those workshops.
11. The business architecture team will work with technical architects / procurement teams (if they already exist) to discuss the scope, business expectations, and priorities that will be important to reflect in system expectations, requirements, and appropriate procurements.
12. The business architecture deliverable will be a consolidation of each section by business area. Each section will be reviewed by its business owner, with the full document being reviewed by all to understand expected dependencies that are factored into each area.
Deliverables and Target Timeline
Through this task order the KPMG team will produce the following deliverables, which will each have a Deliverable Expectation Document (DED) developed:
Responsibilities:
Provide expertise in Healthcare/Medicaid industry trends, and solutions internally to the team and externally to client stakeholders as required. Acts as the Medicaid SMP to the team and externally. Support the rest of the team with any Medicaid specific questions and provide strategic guidance on streamlining their understanding of Medicaid areas, policies and procedures. Researches any Medicaid specific topics of interest as needed to support the team and innovation.
Support the team in planning and development of materials to facilitate workshops for reviewing and validating Business Architecture artifacts and deliverables.
Support the team in preparing and facilitating business architecture workshops with various stakeholders across the client organization according to the approved methodology and approach.
Support the development, review with stakeholders, updating of comprehensive documentation, including business architecture artifacts like but not limited to- context models, process maps.
Analyze and summarize (independently or in support of the team) any provided documentation on business processes, workflows, and system requirements related to assigned areas. Identify and assess gaps.
Collaborate with stakeholders to gather and document pain points and their root cause.
Ensure produced artifacts align with MITA framework and CMS compliance standards as well as with other artifacts developed for the larger project/scope. Reviews team output from the Medicaid SMP perspective.
Facilitate communication between team members, other project teams, business units, and clients from the Medicaid SMP perspective and to, in particular- but not limited to - ensure clear understanding of stakeholders goals, specific needs or ways in which they want to conduct their business/operations in the future.
Provide recommendations informed by own experience and expertise with Medicaid processes and procedures- as appropriate- for process improvement and in alignment with the goals, guiding principles and other documented program constraints.
Provide timely and qualitative updates to the team and team leads as needed.
Contribute to team tasks, documentation preparation and provide support to the immediate and larger team as required.
Experience required:
Solid expertise in Medicaid, MITA and experience with Medicaid operations, policies, systems.
Ten (10) years experience with large-scale Healthcare solutions.
Four (4) years of general IT system experience and formal training/education.
Four (4) years experience in enterprise systems or projects.
Bachelor s degree.
Hands on experience and expertise with Medicaid operations, policy, artifacts.
Successful track record (preferably in IT/Medicaid/HHS or healthcare projects) of organizing, fully preparing, conducting and timely following up on any action items from workshops with diverse stakeholders to review/validate/approve business architecture artifacts.
Proficiency in analyzing business documentation, particularly within large-scale state healthcare programs.
Successfully developing and maintaining working relationships with the rest of the team, the project leadership and the client stakeholders, supporting team members in conceptually address complex Medicaid topics, processes, dependencies, constraints.
Track record of efficiency, attention to detail, responsiveness, flexibility and ability to learn, adapt and work on any given feedback areas.
Working independently on assigned tasks and turning in quality output while being open and proficient acting as part of a larger team, understanding how assigned tasks depend and support other tasks and activities within the larger team.
Preferred:
Experience with New York's state Medicaid system or other Medicaid programs highly advantageous.
Master s Degree.
Two (2) years experience in a large healthcare system.
Any certifications and experience with process improvement techniques (such as Lean Six Sigma, Agile, PDCA cycles, and Kanban), Medicaid, Project Management, Business Analysis, or similar.
Any technical certifications and experience such as ITIL Service Management, Comp TIA certifications, Oracle, Microsoft. Cisco, AWS, certifications, or areas such as IT Governance, IT Auditing, IT Risk Management, etc.
Additional Skills & Qualifications
Experience supporting NYS projects a huge plus
Business Architect project for the state- Must have worked Medicaid & State Government exp is Mandatory.
Job Description
Scope Overview
The scope of services under this Task Order will include KPMG s assistance in documenting, based on DOH s input, a future state business architecture describing how OHIP would like to operate as a result of the broader MES modernization effort. The scope of services under this Task Order includes the development of a business architecture plan that clearly articulates the OHIP business areas in scope and aligns this plan with the larger Enterprise Architecture Management Plan (F11) regarding the sequence of business areas in focus.
Additionally, the scope under this Task Order includes activities focused on providing DOH with an enterprise capability model able to support the desired future state as well as a high-level enterprise operating model supporting the OHIP desired future state.
Furthermore, for each of the business areas in scope, the scope of services under this Task Order will include:
- the documentation of stakeholders and interactions aligned with the respective area (Context Models),
- a compendium of pain points witnessed in current operations and
- the development of optimized future state workflows to support the larger program vision and goals.
Specifically, KPMG will conduct the following activities:
1. Define the scope of this effort regarding both MITA and non-MITA business areas (e.g., NYSOH functions such as customer service and premium billing, including identifying which parts of the business will be included and the extent to which they will need to be included in the business architecture. Initial expectations for business areas to cover include:
Provider management
Business relationship management
Care & Case management
Eligibility & Enrollment (MAGI, Complex Medicaid, APTC)
Member management
Operations management (claims, pharmacy, etc.)
Financial management
Plan management (MCOs)
Performance Management
Contractor management
Customer service
SHOP
Premium payment
2. The KPMG TAS team will review the progress that was made by the initial business architecture proof of concept team, including any standards that were established and agreed upon for documenting business process workflows. KPMG will provide recommendations to DOH regarding revisions based on industry standard architecture practices.
3. Identify dependencies (content and timing) that procurements have on each business areas and each process group with each other to understand priorities, relationships, and sequencing.
4. Develop a plan for how the business architecture effort aligns with the MES Roadmap, and the sequence in which business area documentation will be completed.
5. Establish business owners for each business area identified and establish an enterprise business working group for high level discussions, and more detailed working groups for each business area.
6. Transition relevant KERA reference content from KPMG Sparx tool into the DOH environment and tool of choice (iServer). This transition will be addressed business area by business area as part of the respective business area planning scope and activities.
7. Establish an enterprise-wide capability model that can be used to provide overall context to how OHIP business process areas will operate and review through enterprise level workshops. This will be expedited by the KERA HHS / Medicaid capability models and updates made through the MECM procurement business architecture definition.
8. Conduct detailed workshops for each business area that will review draft content and identify changes. Draft content will leverage KERA reference model business process workflows and business context models (that incorporate MITA requirements).
9. We will begin each business area assuming a 6-week timeline but will scale up or down for each area based on its complexity and the availability of DOH subject matter experts.
10. Each business area will follow a similar pattern for documenting its target business architecture:
Identify the scope of the business area, including discussions on the workflows that should be included in that area.
Review goals / objectives and KPIs for each area and the key pain points that exist in the current state that are targeted for improvement. No current state business process workflows are expected to be developed.
Each business area will include at least one context model describing high level business interactions and a workshop to review drafts and make updates
Map out the high-level business process workflows in scope and plan workshops with appropriate NYS staff according to the number and complexity of these workflows.
Facilitate workshops with DOH staff and relevant stakeholders to review and validate business architecture artifacts.
Identify high-level expectations for future automation of business process workflows, that can be used as a starting point for future requirements discussions.
Document the future state business architecture for each business area as a section in the overall deliverable. Each section will be reviewed individually by the DOH team supporting those workshops.
11. The business architecture team will work with technical architects / procurement teams (if they already exist) to discuss the scope, business expectations, and priorities that will be important to reflect in system expectations, requirements, and appropriate procurements.
12. The business architecture deliverable will be a consolidation of each section by business area. Each section will be reviewed by its business owner, with the full document being reviewed by all to understand expected dependencies that are factored into each area.
Deliverables and Target Timeline
Through this task order the KPMG team will produce the following deliverables, which will each have a Deliverable Expectation Document (DED) developed:
Responsibilities:
Provide expertise in Healthcare/Medicaid industry trends, and solutions internally to the team and externally to client stakeholders as required. Acts as the Medicaid SMP to the team and externally. Support the rest of the team with any Medicaid specific questions and provide strategic guidance on streamlining their understanding of Medicaid areas, policies and procedures. Researches any Medicaid specific topics of interest as needed to support the team and innovation.
Support the team in planning and development of materials to facilitate workshops for reviewing and validating Business Architecture artifacts and deliverables.
Support the team in preparing and facilitating business architecture workshops with various stakeholders across the client organization according to the approved methodology and approach.
Support the development, review with stakeholders, updating of comprehensive documentation, including business architecture artifacts like but not limited to- context models, process maps.
Analyze and summarize (independently or in support of the team) any provided documentation on business processes, workflows, and system requirements related to assigned areas. Identify and assess gaps.
Collaborate with stakeholders to gather and document pain points and their root cause.
Ensure produced artifacts align with MITA framework and CMS compliance standards as well as with other artifacts developed for the larger project/scope. Reviews team output from the Medicaid SMP perspective.
Facilitate communication between team members, other project teams, business units, and clients from the Medicaid SMP perspective and to, in particular- but not limited to - ensure clear understanding of stakeholders goals, specific needs or ways in which they want to conduct their business/operations in the future.
Provide recommendations informed by own experience and expertise with Medicaid processes and procedures- as appropriate- for process improvement and in alignment with the goals, guiding principles and other documented program constraints.
Provide timely and qualitative updates to the team and team leads as needed.
Contribute to team tasks, documentation preparation and provide support to the immediate and larger team as required.
Experience required:
Solid expertise in Medicaid, MITA and experience with Medicaid operations, policies, systems.
Ten (10) years experience with large-scale Healthcare solutions.
Four (4) years of general IT system experience and formal training/education.
Four (4) years experience in enterprise systems or projects.
Bachelor s degree.
Hands on experience and expertise with Medicaid operations, policy, artifacts.
Successful track record (preferably in IT/Medicaid/HHS or healthcare projects) of organizing, fully preparing, conducting and timely following up on any action items from workshops with diverse stakeholders to review/validate/approve business architecture artifacts.
Proficiency in analyzing business documentation, particularly within large-scale state healthcare programs.
Successfully developing and maintaining working relationships with the rest of the team, the project leadership and the client stakeholders, supporting team members in conceptually address complex Medicaid topics, processes, dependencies, constraints.
Track record of efficiency, attention to detail, responsiveness, flexibility and ability to learn, adapt and work on any given feedback areas.
Working independently on assigned tasks and turning in quality output while being open and proficient acting as part of a larger team, understanding how assigned tasks depend and support other tasks and activities within the larger team.
Preferred:
Experience with New York's state Medicaid system or other Medicaid programs highly advantageous.
Master s Degree.
Two (2) years experience in a large healthcare system.
Any certifications and experience with process improvement techniques (such as Lean Six Sigma, Agile, PDCA cycles, and Kanban), Medicaid, Project Management, Business Analysis, or similar.
Any technical certifications and experience such as ITIL Service Management, Comp TIA certifications, Oracle, Microsoft. Cisco, AWS, certifications, or areas such as IT Governance, IT Auditing, IT Risk Management, etc.
Additional Skills & Qualifications
Experience supporting NYS projects a huge plus