Functional Description:
This role requires significant expertise of Medicaid Enterprise System modules and data warehouse or decision support systems. This role provides input and direction supporting a large data warehouse implementation and operations. The selected SME will provide direction to business and technical team members related to claims, provider, and recipient data.
Roles in this function could partner with stakeholders to understand data requirements and support development tools and models such as interfaces, dashboards, data visualizations, decision aids and business case analysis to support the organization. Other roles involved could include producing and managing the delivery of activity and value analytics to external stakeholders and clients. This is a telecommute position with some (<25%) required travel to Springfield, IL for onsite customer meetings.
Primary Responsibilities:
• Provide input and direction supporting decision making for large Medicaid data warehouse implementation and operations.
• Provide Medicaid and CHIP expertise and guidance as it relates to complex processes involving claims processing/adjudication and recipient/provider eligibility, and third-party liability.
• Anticipates state Medicaid agency data needs and proactively develops solutions to meet them
• Guide technical and business teams on healthcare topics understanding and utilizing healthcare data appropriately.
Required Qualifications:
• More than ten (10) years of healthcare data analysis experience supporting business initiatives through data analysis, writing business requirements, and user acceptance testing of various systems.
• More than four (4) years of experience working with/for State Medicaid agencies or equivalent.
• More than two (2) years of experience working in projects like the following with CMS Federal Reporting, quality measures, claims processing, Medicaid program eligibility, provider enrollment, third-party liability.
• Understanding of fee-for-service, managed care claim/encounter adjudication processes from enrollment to funding/finance.
• Excellent verbal/written communication, end 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 up to twenty-five percent (25%).
Preferred Qualifications:
• Experience writing and understand complex Structured Query Language (SQL).
• Experience with data analysis using Teradata Database Management System or other equivalent database management system.
• Experience using JIRA, Rally, DevOps or equivalent.
• Previous experience on large implementation project.
• Located within driving distance (3 - 5 Hours) of Springfield, IL.