Senior Data Analyst - Medicaid Exp Must - W2

CLOUDSCOUTS SOFTWARE SOLUTIONS LLC

9d•Remote

About The Position

We are seeking a Senior Data Analyst with extensive experience in Medicaid healthcare data. The role involves analyzing large volumes of Medicaid data, gathering requirements from stakeholders, developing complex SQL queries, and creating reports and dashboards using BI tools. You will perform detailed analysis of claims, eligibility, provider networks, and reimbursement processes, conduct data quality assessments, and support regulatory reporting. Collaboration with ETL and data engineering teams, impact analysis, and participation in Agile ceremonies are key aspects of this position. Ensuring HIPAA compliance and providing mentorship to junior analysts are also expected.

Requirements

Strong experience in Medicaid programs and healthcare payer systems.
Deep understanding of Medicaid claims processing lifecycle.
Experience with Member Eligibility and Enrollment
Experience with Claims Adjudication
Experience with Provider Management
Experience with Encounters and Capitation
Experience with Prior Authorization
Experience with Care Management
Experience with Pharmacy and PBM data
Experience with ICD-10, CPT, HCPCS, DRG, NDC coding systems
Experience with CMS and State Medicaid reporting

Responsibilities

Analyze large volumes of Medicaid healthcare data, including claims, enrollment, provider, eligibility, encounter, and pharmacy data.
Gather, analyze, and document business and data requirements from Medicaid business stakeholders.
Develop and maintain complex SQL queries, stored procedures, and data validation scripts for data extraction and analysis.
Perform detailed analysis of Medicaid claims adjudication, member eligibility, provider networks, and reimbursement processes.
Design, develop, and maintain dashboards, scorecards, and reports using BI tools such as Tableau, Power BI, or Cognos.
Conduct data profiling, data quality assessments, and root cause analysis to ensure accuracy and completeness of Medicaid data.
Collaborate with business teams to support Medicaid regulatory reporting, including CMS, state-specific mandates, and quality measures.
Analyze healthcare KPIs, utilization trends, cost containment opportunities, and operational metrics.
Support Medicaid programs such as Managed Care, Fee-for-Service (FFS), Dual Eligible, LTSS, and Value-Based Care initiatives.
Work closely with ETL and data engineering teams to validate source-to-target mappings and data transformations.
Perform impact analysis for system enhancements, regulatory changes, and Medicaid policy updates.
Create functional specifications, business requirement documents (BRDs), and data mapping documents.
Participate in Agile ceremonies including sprint planning, backlog grooming, daily stand-ups, and retrospectives.
Ensure compliance with HIPAA regulations and healthcare data security standards.
Provide mentorship and guidance to junior analysts and team members.