Medicaid Data Specialist

EDW 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.

Functional Description:

This position is a Medicaid Data Specialist for the Illinois Enterprise Data Warehouse supporting the
State of Illinois Medicaid program. This role requires significant expertise of Medicaid Enterprise System
modules and data warehousing or decision support systems. This role provides the guidance and
direction to support a large data warehouse implementation and maintenance & operations. The
selected candidate will provide the required decisions for the business and technical team members to
modify, change, enhance or correct within the system, related to claims, provider, and recipient data.
Roles in this function will partner with stakeholders to understand data requirements and support
development and models such as interfaces, dashboards, data visualizations, decision aids and business
case analysis to support the organization. Additional roles include producing and managing the delivery
of activity, value analytics and critical deliverables to external stakeholders and clients. This is a
telecommute position with some (<15%) required travel to Springfield, IL for onsite customer meetings.

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:

Master's Degree preferred
More than 2 years of experience working with PERM, T-MSIS, CMS Federal Reporting or
similar projects
More than 2 years of experience in Adult/Child Core measures, 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 in large implementation projects.
Located within driving distance (3 - 5 Hours) of Springfield, IL.