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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.