Role Description - Data Architecture & Design: - Design and maintain enterprise data architecture for structured and semi-structured healthcare data. - Define logical, conceptual, and physical data models. - Establish data standards, naming conventions, and metadata management practices. - Support event-driven and API-based data architectures. - Align data architecture with CMS interoperability mandates (FHIR, HL7). - Data Analysis & Insights: - Analyze large healthcare datasets to identify patterns, trends, and anomalies. - Support fraud, waste, and abuse (FWA) detection efforts through data analysis. - Develop analytical datasets and data marts for reporting and investigations. - Partner with business stakeholders to translate requirements into data solutions. - API & Streaming Integration: - Support data design for API Gateway integrations (MuleSoft or similar). - Ensure data consistency across Kafka streaming pipelines and batch sources. - Define data contracts and schemas for real-time data exchange. - Validate data transformations and mappings across source and target systems. - Data Governance & Quality: - Implement data governance, lineage, and stewardship practices. - Monitor and improve data quality, accuracy, and completeness. - Support data audits, validations, and remediation efforts. - Ensure compliance with HIPAA, CMS, FISMA, and NIST standards. - Reporting & Visualization: - Design and support reports, dashboards, and analytics for program integrity and operations. - Support ad-hoc data requests from investigators and oversight teams. - Collaboration & Documentation: - Work closely with architects, developers, QA, and security teams. - Participate in Agile ceremonies and data design reviews. - Maintain comprehensive documentation of data models, mappings, and architecture decisions. Qualifications - Bachelor’s degree in Computer Science, Data Science, Information Systems, or related field. - 5+ years of experience in data architecture and/or data analysis. - Strong experience with data modeling (ER, dimensional, normalized models). - Proficiency in SQL and data analysis techniques. - Experience working with large enterprise data environments. Requirements - Experience supporting CMS, Medicaid, or federal healthcare programs. - Knowledge of HL7 FHIR and healthcare data standards. - Knowledge of CMS CPI systems like PECOS; APS. - Understanding of CMS Medicare Program Integrity Manual. - Experience with API-driven data integration (MuleSoft preferred). - Familiarity with Kafka or streaming data platforms. - Experience with cloud data platforms like AWS. Benefits - The actual salary offer will carefully consider a wide range of factors, including your skills, qualifications, experience, and location. - C-HIT offers Healthcare Benefits, Remote Working Options, Paid Time Off, PTO cash-out, Training/Certification opportunities, Healthcare Savings Account & Flexible Savings Account, Paid Life Insurance, Short-term & Long-term Disability, 401K Match & Profit sharing, Employee Assistance Program, Paid Holidays, and much more perks and Voluntary benefits! - Employees of C-HIT shall, as an enduring obligation throughout their term of employment, adhere to all information security requirements as documented in company policies and procedures. Company Description C-HIT, a CMMI Maturity Level 5 company, focuses on delivering information technology and professional services to Federal and State agencies. "C-HIT is an EOE, including disability and veterans.”

• Own and lead the full implementation lifecycle for large, complex, or strategic clients from initiation through production deployment, ensuring all contractual deliverables are met on time and within scope. • Serve as the primary benefits configuration expert on client implementations, leading all discovery, requirements gathering, and configuration sessions. • Anticipate and proactively mitigate implementation risks; develop contingency plans and communicate issues to leadership with recommended solutions. • Review and validate benefit set-ups performed by junior analysts prior to client go-live. • Configure and maintain complex benefit designs, clinical rules, pharmacy networks, pricing structures, accumulators, and hierarchies across the RxSense platform. • Develop deep expertise in RxSense claims platforms and serve as an internal resource for platform capabilities and limitations. • Lead root-cause analysis on complex benefit set-up issues; develop and implement process changes to prevent recurrence. • Conduct impact analysis for platform changes, client requests, and identified issues affecting benefit configurations. • Build and sustain trusted advisor relationships with clients, serving as a consultative partner on benefit design strategy and platform optimization. • Represent Benefits Administration in cross-functional meetings, client steering committees, and escalation calls. • Partner with Client Services, Pharmacy Networks, UAT/QA, IT, Finance, and Clinical teams to drive flawless implementations and ongoing client satisfaction. • Provide mentorship, training, and day-to-day guidance to Benefits Administration Analysts and other team members. • Develop and deliver training materials for internal staff and private-label clients on benefit set-up requirements and platform best practices. • Act as an escalation point for the team on complex or ambiguous benefit configuration challenges. • Identify and lead initiatives to improve departmental workflows, documentation, and quality standards. • Assist the Director in developing and maintaining department policies, procedures, and best practices. • Contribute to strategic projects and product initiatives as a subject matter expert.

Role Description The Utilization Management Coordinator pursues and secures authorizations from any and all payers. Ensures appropriate utilization of services at Connections Health Solutions clinics, observation and inpatient units. Facilitates maximum appropriate payment through support of concurrent review of inpatient care by any payer. Obtains prior authorization for service as required. - Works with all payers to secure authorization for inpatient stays for all individuals admitted to Inpatient or COE Unit. - Performs utilization review in accordance with all Payor requirements, State Regulations, and Joint Commission Standards. - Ensures all payer utilization management staff receive needed daily information to perform their reviews. - Obtain authorizations for previously identified procedures where required. - Reviews medical records and evaluates patient progress towards discharge. - Performs continuing review on medical records and identification and need for on-going inpatient services. - Obtains necessary medical reports, treatment plans and validates BHMP’s progress notes/evaluations for appropriate justifications of continued stay. - Documents review information as required by State and Payor regulations. - Communicates results to applicable payor sources, including requests to BHMP’s for expedited follow-up to all payer UM staff. - Complies with regulation changes affecting utilization management. - Facilitates educational programs and advises physicians and other departments of regulations affecting utilization management. - Performs all other duties as assigned. This is a fully remote position in these states: AL, AR, AZ, CA, CO, CT, DC, FL, GA, IA, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MT, NC, NJ, OH, OR, PA, RI, SC, TN, TX, UT, VA, WA. Qualifications - High School Diploma or equivalent - At least 2 years of behavioral health experience - Expertise in Utilization Management responsibilities, tasks and functions, and/or Clinical auditing experience Requirements - The Company has a mandatory vaccination policy. All successful applicants must be fully vaccinated, including showing proper documentation, or otherwise be exempt pursuant to the Company’s exemption process prior to their start date as a condition of employment. Benefits - Full-time only: Employees (and their families) are offered comprehensive health insurance, including Medical, Dental, Vision, Accident, Critical Illness, and Hospital Indemnity. - CHS pays for Basic Life, AD&D, Short and Long-Term Disability. - Voluntary Life insurance option for employees and their families. - Health Savings Accounts (with $1,000 to $2,000 employer contribution depending on plan). - Flexible Spending Accounts (health care and dependent care). - 401k company match after 6 months (50% of deferrals up to 6% of compensation). - Generous PTO starting at 160 hours accrued annually and 12 recognized company holidays. - Company‑paid parental leave available to eligible employees. - All employees (Pool, Part-time and Full-time): Employee Assistance Program to help with confidential emotional support, work life solutions, financial solutions, legal assistance, or online support. - After 90 days, you are auto enrolled in the 401k Plan.

Location: Wausau United States Job Description: The Recovery Administration Specialist is responsible for carrying out clerical duties on delinquent consumer loans within a charged-off portfolio of accounts and for helping support collection efforts on the accounts in varying capacity. - This is considered a hybrid role, with a combination of onsite work in Wausau, WI and remote work from home. The standard schedule is Monday through Friday, 8:00 a.m. - 4:30 p.m. Essential Functions - Complete clerical duties for accounts, to include but not be limited to, answering phones, making phone calls, entering data, filling in forms, and keeping/updating records/spreadsheets - Successfully negotiate with consumers or authorized third parties for payment in full, settlement, or monthly payments on accounts - Provide support in skip-tracing accounts when necessary - Manage third party placements and communicate with third party vendors regarding those placements Required Education And Experience - High School Diploma or GED equivalent required - 2 years Customer Service and/or Administrative or Clerical experience required - 6 months of collection experience preferred - 6 months of administrative or clerical experience required - Financial industry experience preferred - Bilingual (English and Spanish) candidates preferred - Attention to detail and accuracy required - Excellent verbal and written communication skills required - Proficient in the utilization of Microsoft Office Suite - Ability to thrive in a fast-paced work environment Physical Demands While performing the duties of this job, the employee is frequently required to sit, stand, walk, visualize, talk, hear, and handle or touch objects or controls. The employee may occasionally lift, push, or pull up to 20 pounds. This position is an office-based position where you must be able to sit for long periods of time. The employee will be working on a computer 90% of the time.