EDW Medicaid Subject Matter Expert/Data Specialist

Vytwo

176d • Remote

About The Position

This role serves as the Medicaid Subject Matter Expert for the Illinois Enterprise Data Warehouse supporting the State of Illinois Medicaid program. It requires significant expertise in Medicaid Enterprise System modules and data warehousing or decision support systems. The SME provides guidance and direction for a large data warehouse implementation and its maintenance and operations, making or supporting business and technical decisions about changes, enhancements, and corrections to claims, provider, and recipient data.

The position partners with stakeholders to understand data requirements and supports the development of interfaces, dashboards, data visualizations, decision aids, and business case analyses. It also involves producing and managing delivery of activity and value analytics and critical deliverables for external stakeholders and clients. The role is remote/telecommute, with less than 25% required travel to Springfield, Illinois for onsite customer meetings. The posting requires U.S. citizenship.

Requirements

• Must be a U.S. citizen.
• More than 10 years of information technology experience.
• Five years of experience working directly with or for state Medicaid agencies, or equivalent experience supporting business initiatives through data analysis, writing business requirements, and testing or validating systems.
• More than five years serving as a subject matter expert for CMS and state Medicaid federal reporting, including T-MSIS, PERM, MARS, and other CMS-mandated submissions.
• Understanding of claims, recipient and eligibility, and provider and enrollment data processes.
• Advanced SQL proficiency and more than five years of experience analyzing large Medicaid datasets, including claims, eligibility, provider, and federal extracts, in an EDW environment.
• Knowledge of Centers for Medicare and Medicaid Services reporting requirements and covered programs.
• Excellent verbal and written communication and presentation skills.
• Manager-, executive-, or director-level client-facing experience, team collaboration, and mentoring skills.
• Ability to travel to Springfield, Illinois two to three times per year (the posting separately states two to three to four times per year).
• Demonstrated alignment with the stated culture values: Integrity, Compassion, Inclusion, Relationships, Innovation, and Performance.

Nice To Haves

• More than two years of experience with HEDIS, CHIPRA, or similar quality metrics.
• Experience with Teradata Database Management System or an equivalent database management system.
• Experience using JIRA, Rally, DevOps, or an equivalent tool.
• Previous experience on a large implementation project.
• Located within a three- to five-hour driving distance of Springfield, Illinois.

Responsibilities

• Provide direction, guidance, and recommendations to support decisions for a large Medicaid data warehouse implementation and its operations.
• Lead and guide internal and external stakeholders on complex Medicaid processes, including claims processing and adjudication, recipient and provider eligibility, and third-party liability.
• Identify state Medicaid agency data needs and recommend solutions supported by credible reasoning, justification, and validated proofs of concept.
• Guide technical and business teams in understanding and appropriately using healthcare data.
• Recommend enhancements and improvements to project processes based on Medicaid best practices, standards, and policies.
• Support business and technical decisions involving modifications, changes, enhancements, or corrections to claims, provider, and recipient data.
• Partner with stakeholders to understand data requirements and support development of interfaces, dashboards, data visualizations, decision aids, and business case analyses.
• Produce and manage delivery of activity and value analytics and critical deliverables for external stakeholders and clients.
• Support federal reporting and ensure data accuracy, compliance, and audit readiness for CMS- and state-mandated submissions.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed