Lead Behavioral Health Consultant

Senior/Lead Behavioral Health Consultant

Pierre, SD (Remote with occasional travel)

12+ months Contract

Scope / Background:

This position is part of Client’s Rural Health Transformation initiative, which focuses on strengthening rural healthcare systems and improving access to quality care across the state. Under this effort, the Client’s division wants a qualified vendor to evaluate the current billing, data collection, and reporting systems used by DBH, Client Medicaid, and providers working toward CCBHC certification or becoming a DCO. The goal is to create a technology roadmap that supports CCBHC-related billing, reporting, and data collection, including better data sharing between EHRs and state systems.

Project Overview:

The selected candidate will assess current systems and provide a roadmap with:

• Detailed recommendations
• Timelines
• Estimated effort
• Technology gap analysis
• Fiscal impact analysis
• Provider education recommendations
• Specific system change recommendations for CCBHC and DCO needs

Systems to be reviewed include:

• STARS (State Treatment Activity Reporting System)
• MMIS (Medicaid Management Information System)
• Up to 11 Community Mental Health Center EHR systems
• Other selected provider EHRs tied to CCBHC/DCO readiness

Type of Project:

This is a Behavioral Health Modernization / Systems Evaluation and Technology Roadmap Project. More specifically, it is a consulting and assessment project focused on CCBHC systems evaluation, billing/reporting readiness, and technology roadmap development.

Required Skills/Experience:

• 8+ years of experience as a Behavioral Health Consultant – CCBHC / DCO / Medicaid Systems
• 10+ years’ experience as a Senior / Lead Behavioral Health Consultant

Experience Requirement:

• Demonstrated understanding, experience, and expertise in CCBHC and DCO data collection, reporting, and payment best practices.
• Experience working with state Medicaid systems, MMIS, behavioral health providers, and various EHRs.
• Experience evaluating billing, data collection, and reporting systems and supporting a technology roadmap with directions, recommendations, timelines, and estimated effort.
• Experience with stakeholder engagement with state and providers, including presenting data gathering, evaluation, analysis, and recommendations.
• Experience in similar settings to South Dakota, especially agencies serving large geographical regions in predominantly rural settings.
• Experience supporting change management for provider and state adoption of new processes and systems.
• Experience creating and implementing data gathering methods, including timelines and secure handling of collected information.
• Experience recommending data collection, reporting, and billing methodologies, including impact assessment and action plans for providers, STARS, and MMIS.
• Experience defining performance indicators such as data accuracy, timeliness, and provider adoption, and recommending provider training and education.

Skill Set Requirement:

• Strong knowledge of CCBHC and DCO operations, reporting, billing, and payment models.
• Knowledge of Medicaid payer models, including the two required paths:
• CCBHC with Medicaid as payer via PPS rate
• Medicaid and state-funded pathway for income-qualified non-Medicaid individuals using the same PPS rate.
• Strong knowledge of state Medicaid systems, MMIS, STARS, and provider EHR ecosystems.
• Ability to assess technology gaps and recommend specific system changes to support the CCBHC and DCO model.
• Ability to support data sharing between EHRs, state systems, and EHR-to-state systems.
• Knowledge of CMS guidelines, HIPAA, South Dakota DSS policies, South Dakota Medicaid policies, and state IT security standards.
• Knowledge of secure data handling, including encryption and secure transfer protocols.
• Ability to prepare a comprehensive assessment, methodology and findings, fiscal impact analysis, provider education recommendations, and system change recommendations.
• Ability to contribute to a preliminary project work plan, project management plan, status reporting, and information-sharing approach.

Education Background:

Education and training in a relevant field. Master’s degree preferred.