Medicaid Subject Matter Expert/Data Specialist

Functional Description: This position is a Medicaid Subject Matter (SME) Expert for the Enterprise Data Warehouse supporting the State 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 for both DDI and maintenance & operations. Based on State requirements, the selected SME 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 include partnering with stakeholders to understand data requirements and supporting development tools and models such as interfaces, dashboards, data visualizations, decision aids and business case analysis to support the State. 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 (

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 (CHIP), lead and guide internal and external stakeholders to make determinations relating to complex processes involving claims processing/adjudication, recipient eligibility, provider enrollment, 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 technical and business teams on understanding healthcare topics 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.
• More than 2 years of experience working CMS Federal Reporting MARS, PERM, T-MSIS, Quality of Care CMS Core Measure or similar projects
• 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.
• Ability to travel to Springfield, IL two (3) to three (4) times per year or as needed.

Preferred Qualifications

• Strong culture fit, demonstrating our culture values in action (Integrity, Compassion, Inclusion, Relationships, Innovation, and Performance).
• Experience using JIRA, Rally, DevOps or equivalent.
• Previous experience on large implementation or DDI project.
• Located within driving distance (3 - 5 Hours) of Springfield, IL.