Medicaid Subject Matter Expert/Data Specialist in EDW Environment

Primary Responsibilities:

• Provide direction, guidance and recommendations supporting decision making for large Medicaid data warehouse implementation and operations.
• With the specialized knowledge of the Medicaid and Children’s Health Insurance Programs, lead and guide internal and external stakeholders to make determinations relating to complex processes involving claims processing/adjudication, recipient/provider eligibility, and third-party liability.
• Proactively identify and understand state Medicaid agency data needs and determines the recommended solution to meet them with credible reason, justification and validated proof of concepts.
• Direct technical and business teams on healthcare topics understanding and utilizing healthcare data appropriately.
• Proactively suggest and recommend enhancements and improvements throughout the project processes, driven by Medicaid best practices, standards and policies.

Required Qualifications:

• More than ten (10) years of experience in information technology with five (5) years of the experience working directly with/for State Medicaid agencies or equivalent supporting business initiatives through data analysis, writing business requirements and testing/validation of various systems.
• Understanding of claims, recipient/eligibility, and provider/enrollment data processes.
• Able to create and perform data analysis using SQL, Excel against data warehouses utilizing large datasets.
• Knowledge of the Centers for Medicare and Medicaid Services reporting requirements and the programs covered.
• Excellent verbal/written communication and presentation skills, manager/executive/director-level client facing, team collaboration, and mentoring skills.
• Strong culture fit, demonstrating our culture values in action (Integrity, Compassion, Inclusion, Relationships, Innovation, and Performance).
• Ability to travel to Springfield, IL two (3) to three (4) times per year.

Preferred Qualifications:

• More than 2 years of experience working with PERM, T-MSIS, CMS Federal Reporting or similar projects
• More than 2 years of experience in HEDIS, CHIPRA or similar quality metrics
• Experience with data analysis using Teradata Database Management System or other equivalent database management system.
• Experience using JIRA, Rally, DevOps or equivalent.
• Previous experience on large implementation project.
• Located within driving distance (3 - 5 Hours) of Springfield, IL.