Senior Data Analyst - Medicaid Exp Must - W2

Job Title: Senior Data Analyst – Medicaid Exp Must
Experience : 10+ Years


Key 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. 

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