Senior Data Analyst - Medicaid Exp Must - W2
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AI Summary
Analyze large volumes of Medicaid healthcare data to support regulatory reporting and operational metrics. Develop complex SQL queries and BI dashboards to monitor claims adjudication, member eligibility, and provider networks.
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
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
This is a remote position.
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