Medicaid Subject Matter Expert/Data Specialist in EDW Environment

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 four (4) years of experience working directly with/for State Medicaid agencies or
equivalent.
• More than seven (7) years of healthcare data analysis experience supporting business
initiatives through data analysis, writing business requirements, and user acceptance testing
of various systems.
• More than two (2) years of experience working in projects like the following: 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.

Functional Description:
This position is a Medicaid Subject Matter Expert for the Illinois Enterprise Data Warehouse supporting
the State of Illinois Medicaid program. This role requires significant expertise of Medicaid Enterprise
System modules and data warehouse or decision support systems. This role provides the guidance and
direction to support a large data warehouse implementation and operations. 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 will 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. 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 (<25%) required travel to Springfield, IL for onsite customer meetings.