Medicaid Data Specialist

Primary Responsibilities:
Provide data and information 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 determine the
recommended solution to meet them with credible reason, justification and validated proof of
concepts.
Direct and train 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.