Medicaid Data Warehouse and Encounter Claim Processing Transition Lead

Job#: 2076668

Job Description:

Job Description Summary:

The Medicaid Data Warehouse and Encounter Claim Processing Transition Lead will be responsible for leading the successful transition of the our clients Medicaid data warehouse and encounter processing solution to an internally-managed solution. 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.

EEO Employer

Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at or .

Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing in Talent Satisfaction in the United States and Great Place to Work in the United Kingdom and Mexico.

Apex Benefits Overview: Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our 'Welcome Packet' as well, which an Apex team member can provide.