Medicaid Subject Matter Expert / Data Specialist

Description

The Medicaid Subject Matter Expert (SME) will support an Enterprise Data Warehouse for a state Medicaid program. This role requires advanced expertise in Medicaid Enterprise System modules, data warehousing, and decision support systems to provide direction and recommendations for a large Medicaid data warehouse implementation and operations. The SME will guide internal and external stakeholders on complex processes related to claims processing, recipient/provider eligibility, and third-party liability. The role involves providing decisions to support system modifications related to claims, provider, and recipient data, and guiding technical and business teams. Additionally, the SME will work closely with stakeholders to understand data requirements and support the development of interfaces, dashboards, data visualizations, decision aids, and business case analysis.

Primary Responsibilities:

• Provide direction, guidance, and recommendations to support decision-making for the large Medicaid data warehouse implementation and ongoing operations.
• Lead and guide stakeholders on Medicaid and Children’s Health Insurance Programs to address complex processes involving claims processing/adjudication, eligibility, and third-party liability.
• Proactively identify and understand state Medicaid agency data needs and recommend effective solutions, providing credible justification and validated proof of concepts.
• Direct technical and business teams on healthcare topics, ensuring healthcare data is understood and utilized appropriately.
• Suggest and recommend project enhancements and improvements based on Medicaid best practices, standards, and policies.

Requirements

• More than ten (10) years of experience in information technology, with at least five (5) years of experience working directly with State Medicaid agencies or equivalent, supporting business initiatives through data analysis, business requirements writing, and system testing/validation.
• Strong understanding of claims, recipient/eligibility, and provider/enrollment data processes.
• Proficient in performing data analysis using SQL, Excel, and large datasets within data warehouses.
• Knowledge of Centers for Medicare and Medicaid Services (CMS) reporting requirements and relevant programs.
• Excellent verbal and written communication, presentation, and collaboration skills, with experience working with manager/executive-level clients.
• Strong cultural fit, demonstrating company values in action: Integrity, Compassion, Inclusion, Relationships, Innovation, and Performance.
• Ability to travel to Springfield, IL 2-3 times per year.

Preferred Qualifications:

• More than 2 years of experience working with PERM, T-MSIS, CMS Federal Reporting, or similar projects.
• More than 2 years of experience with HEDIS, CHIPRA, or similar quality metrics.
• Experience with data analysis using Teradata Database Management System or equivalent.
• Experience using JIRA, Rally, DevOps, or similar tools.
• Previous experience in large implementation projects.
• Located within 3-5 hours driving distance from Springfield, IL.

Physical Requirements & Environmental Conditions:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this position, the employee is regularly required to sit and use hands to handle, or feel objects, a keyboard and other office equipment. The employee frequently is required to sit in meetings for long periods of time. The employee will utilize technology tools such as a laptop computer for extended periods of time. The employee must be able to reach with hands and arms and talk or hear. Specific vision abilities required by this position include close vision, color vision, and the ability to adjust focus.

Briljent is a solutions-based company. Solutions come from creative ideas; ideas come from being creative with differences. Briljent believes diversity and inclusion are critical to the success of the company. Employment at Briljent is based on merit and professional qualifications. We do not discriminate against any employee or applicant because of race, creed, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, veteran status, marital status or any other basis protected by federal, state or local law, regulation or ordinance.