Hello;
Title: Technical Analyst
Location is Remote
Long Term
We are seeking a Technical Analyst with strong experience in Medical Management compliance reporting to support regulatory and operational reporting needs. The role will focus on development, validation, and submission of compliance reports such as ODAG (Organization Determination Appeals and Grievances), CDAG (Coverage Determination Appeals and Grievances), and other CMS-mandated reporting for Medical Management functions. This role requires close collaboration with business (UM/CM teams), data teams, and IT stakeholders to ensure accuracy, timeliness, and compliance with regulatory standards. Key Responsibilities Develop, enhance, and maintain Medical Management compliance reports including ODAG, CDAG, and related CMS submissions Analyze regulatory requirements and translate them into technical specifications and reporting logic Perform data validation, reconciliation, and audit support to ensure report accuracy and compliance readiness Partner with Utilization Management (UM) and Care Management (CM) teams to refine reporting requirements Work with data sources across Core Admin, UM platforms (e.g., MHK), and downstream systems Support submission cycles, including pre-validation, error resolution, and final reporting deliverables Ensure compliance with CMS guidelines and internal audit controls Identify opportunities for automation and optimization in reporting processes Required Skills & Experience 5+ years of experience in Healthcare Payer domain (Medicare Advantage preferred) Hands-on experience with Medical Management compliance reporting (ODAG, CDAG, CMS reporting) Strong understanding of Utilization Management (UM) and Care Management (CM) workflows Experience working with healthcare data models and regulatory datasets Proficiency in SQL, data analysis, and reporting tools Experience with systems such as MHK (MedHOK), Core Admin platforms (IKA/QNXT/Facets or similar) Familiarity with data validation, reconciliation, and audit processes Strong analytical and problem-solving skills Preferred Skills Experience with CMS audit support and compliance submissions Exposure to Azure-based data environments or modern data platforms Knowledge of EDI transactions (837/835) and claims lifecycle Experience in automation or reporting optimization initiatives
Technical Analyst Proficiency Advanced
Mandatory Skills
Medical Management Compliance Reporting Expertise Hands-on experience with ODAG, CDAG, and CMS regulatory submissions
Healthcare Payer Domain Knowledge Strong understanding of Medicare Advantage, UM (Utilization Management), and CM (Care Management) workflows
Data & Reporting Skills Proficiency in SQL, data validation, reconciliation, and compliance reporting
Good to Have Skills
Platform Experience Exposure to MHK (MedHOK) or other Core Admin systems (IKA/QNXT/Facets)
Cloud/Data Modernization Exposure Experience with Azure or modern data platforms
Regulatory & Audit Support Familiarity with CMS audits, compliance validations, and submission cycles
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