What You'll DoYou'll own the day-to-day documentation, coordination and analysis that keep Medicaid reporting deliverables moving, with limited supervision and guidance from the Medicaid SME:
- Gather, document, and manage business requirements for EDW reports, extracts, and enhancements, including federal reporting such as CMS-64/CMS-21 support, MARS, T-MSIS, and PERM.
- Analyze current business processes and systems and document requirements for new or changed processes.
- Help translate federal and State Medicaid policy and reporting guidance into business rules and requirements, with direction from the Medicaid SME.
- Write clear requirements artifacts: business requirements, business rules, use cases, user stories, acceptance criteria, data mappings, and process flows.
- Maintain requirements traceability from request through design, testing, and delivery.
- Schedule and facilitate working sessions with State business users, Optum technical teams, and other partners. Capture minutes, decisions, action items, and follow-ups.
- Track open questions, dependencies, and risks for assigned work, and escalate issues to the SME and project lead when needed.
- Write SQL to profile and analyze Medicaid enrollment, eligibility, provider, claims, encounter, and financial data to answer business questions and confirm requirements.
- Identify and document data anomalies and report variances, and work with ETL, BI, and QA teams to resolve them.
- Share use cases with data and quality analysts for profiling, review results, and confirm alignment with project requirements and Medicaid/CMS guidelines.
- Support testing and UAT, including test scenarios, acceptance criteria, defect reporting, and follow-up.
- Prepare presentations, summaries, and status updates for the SME, internal leadership, and the customer.
- Maintain business documentation, data definitions, the Operations Guide, and related process documentation in SharePoint and Azure DevOps.
- Support end-user training and training materials related to reports and data.
- Mentor junior analysts and serve as backup to the Medicaid SME on day-to-day business questions and reporting processes.
- Peer review project artifacts and help manage intake and change requests, including impact analysis and BA effort estimates.
Requirements
- Bachelor's degree in business, information systems, public health, or a related field, or equivalent experience.
- 8+ years of business analysis experience, including requirements gathering, documentation, stakeholder facilitation, and user acceptance testing.
- 5+ years of experience working with healthcare data such as claims, encounters, eligibility/enrollment, provider, or financial data.
- 3+ years of experience with Medicaid or public-sector healthcare programs, such as State Medicaid/CHIP agencies, MMIS/MES vendors, Medicaid data warehouses, or Medicaid managed care plans.
- 3+ years of experience writing SQL to analyze and validate data in a relational database or data warehouse.
- Understanding of Fee for Service and managed care claim adjudication, from eligibility and enrollment through claims processing to funding/finance, including managed care encounters.
- Basic understanding of CMS reporting requirements for Medicaid.
- Experience writing use cases, user stories, and acceptance criteria and supporting testing/UAT.
- Experience facilitating meetings and documenting outcomes.
- Proficient in MS Word, Excel, PowerPoint, Visio, MS Project, SharePoint, and Teams.
- Strong written and verbal communication skills, with the ability to explain data findings to both technical and non-technical audiences.
- Organized and detail-oriented, and able to manage competing priorities and tight deadlines with limited supervision.
- Ability to travel to Springfield, IL up to three (3) times per year or as needed.
Bonus Experience- Experience with CMS federal reporting such as CMS-64/CMS-21, MARS, T-MSIS, PERM, or similar projects.
- Knowledge of quality measures such as CMS Core Set, HEDIS, or CHIPRA.
- Knowledge of health insurance, HMO, and managed care principles, including Medicaid and Medicare regulation, the Affordable Care Act, and eligibility.
- Experience on a Medicaid Enterprise System (MES)/MMIS or Enterprise Data Warehouse DDI project.
- Experience with Teradata and SQL Assistant/Query Studio, Business Objects, Tableau, or Power BI.
- Familiarity with ETL and reporting processes.
- Experience with knowledge management tools such as Microsoft 365, SharePoint/Teams, and AI-enabled search.
- Experience with Azure DevOps or JIRA, and Agile/Scrum projects.
- CBAP, CCBA, or PMI-PBA certification.
- Located within driving distance of Springfield, IL.
