Medicaid Data Warehouse and Encounter Claim Processing Transition Lead

.**************** DIRECT CLIENT REQUIREMENT *****************

Job Description Summary:

The Medicaid Data Warehouse and Encounter Claim Processing Transition Lead will be responsible for leading the successful transition of the state's Medicaid data warehouse and encounter processing solution to a state-run and managed model. This role will coordinate transition activities, including the development of key deliverables required for transition and sustainable ongoing operations. The Transition Lead will coordinate activities of a team of data and operational experts, collaborate with project management, and ensure that all transition goals align with state and federal requirements.

Job Responsibilities:

• Transition Management:
• Coordinate the transition of the Medicaid data warehouse and encounter claim processing solution from vendor management to a state-run model.
• Oversee and manage a team responsible for technical and operational aspects of the transition and ongoing data warehouse operations.
• Develop and author transition deliverables, including operational documentation, data migration plans, system integration strategies, and reporting requirements
• Develop and execute transition plans, including risk mitigation and knowledge transfer
• Document transition processes and manage transition readiness checklists.
• Operations Management:
• Manage and oversee the daily operations of the Medicaid Data Warehouse, ensuring seamless functionality.
• Monitor ETL processes, data pipelines, and system performance to prevent downtime and inefficiencies.
• Establish and enforce operational procedures for data ingestion, validation, transformation, and reporting.
• Collaborate with technical teams to implement automation, performance improvements, and scalability solutions.
• Work closely with business users to understand reporting and data access needs.
• Team Leadership and Collaboration:
• Lead and mentor a team of analysts, engineers, and support staff responsible for Medicaid Data Warehouse operations.
• Serve as the primary liaison between IT, business stakeholders, and state Medicaid agencies.
• Conduct regular meetings to provide updates on operational status, performance metrics, and transition progress.
• Issue Resolution and Support:
• Lead troubleshooting and root cause analysis for operational issues, working with data engineers and support teams.
• Establish and maintain SLAs for issue resolution and operational support.
• Provide guidance to teams on resolving Medicaid data anomalies, claim processing errors, and eligibility discrepancies.
• Compliance and Security:
• Ensure compliance with CMS (Centers for Medicare & Medicaid Services) regulations, HIPAA, and state Medicaid data governance policies.
• Implement security protocols for data access, storage, and sharing in accordance with regulatory requirements.
• Oversee audits and reporting processes to maintain data accuracy and integrity

Required Credentials and Experience:

• 7+ years of experience in Medicaid data warehouse operations, transition projects, or healthcare data management
• Experience in large-scale system transitions, implementations, or migrations in a government or healthcare setting.
• Strong leadership skills with the ability to manage cross-functional teams and complex projects.
• Deep understanding of Medicaid data structures, encounter processing, federal reporting requirements, and data governance.
• Foundational knowledge of ETL processes, cloud-based data warehouses (AWS, Azure, Snowflake), and SQL.
• Experience working with state Medicaid agencies or MMIS (Medicaid Management Information Systems).
• Strong technical writing skills with experience authoring operational documentation and transition plans.
• Ability to analyze and interpret complex healthcare data to drive informed decision-making.
• Familiarity with cloud-based data warehouse solutions and modern data processing tools.
• Strong knowledge of data security best practices and compliance requirements, including HIPAA.

Preferred Credentials and Experience:

• Experience with Medicaid Enterprise Systems (MES) modernization efforts.
• Prior experience working with CMS (Centers for Medicare & Medicaid Services) on Medicaid data initiatives.

This role is an excellent opportunity for a seasoned Medicaid data expert who is eager to lead a high-impact transition and contribute to the long-term success of a state-run Medicaid data warehouse. If you have the required experience and leadership capabilities, we encourage you to apply.