Primary Responsibilities:
- Provide 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 determines the recommended solution to meet them with credible reason, justification and validated proof of concepts.
- Direct 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.
Preferred Qualifications:
- More than 2 years of experience working with PERM, T-MSIS, CMS Federal Reporting or similar projects
- More than 2 years of experience in 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 on large implementation project.
- Located within driving distance (3 - 5 Hours) of Springfield, IL.