What You'll Do- Engage with business and technical stakeholders to gather, analyze, document, define, and standardize business/data requirements (2%).
- Perform or lead Gap Analysis between as-is and to-be systems to identify shortcomings (5%).
- Develop and maintain documentation including requirement specifications, RTMs, acceptance criteria, process flows, and data mapping documents, using SharePoint and Confluence for version control and collaboration (2%).
- Design, develop, and optimize complex data models and validation frameworks using SQL and Teradata (5%).
- Perform/conduct comprehensive root cause analysis for data quality issues and develop/implement solutions or automated preventive controls (5%).
- Represent the State/organization in interactions with the CMS federal team (alongside manager or as lead SME), addressing queries and serving as subject matter expert on CMS reporting standards (5%).
- Oversee or ensure timely, accurate, error-free, and compliant submission of monthly extracts and quarterly CMS reports (claims, provider, eligibility, CMS-64.9 forms) (5%).
- Lead enterprise level analytical initiatives supporting CMS reporting systems and Indiana healthcare programs (5%).
- Conduct advanced data analysis, modeling, and automation using Excel (Power Query, Power Pivot, VBA macros, complex formulas, dynamic arrays, and scenario modeling) (10%).
- Develop and maintain interactive dashboards and visualizations using Tableau and Power BI to identify trends, anomalies, compliance risks, and key performance metrics for executive and federal reporting (7%).
- Define and implement enterprise data quality governance frameworks, KPIs, automated validation rules, and monitoring systems (5%).
- Lead and coordinate complex testing/QA/UAT activities by establishing strategies, overseeing execution, and reviewing test cases prepared by junior analysts (5%).
- Provide mentorship and technical leadership to junior analysts on advanced SQL, Informatica ETL, Power BI/Tableau development, and CMS processes (10%).
- Recommend and drive implementation of process enhancements, tool upgrades, and automation initiatives for efficiency and compliance (10%).
- Manage and analyze Treatment Episode Data Set (TEDS) Admission and Discharge data submissions for the Division of Mental Health and Addiction (DMHA) (4%).
- Collaborate with the CMS State Support Team to analyze, document, and implement TMSIS (Transformed Medicaid Statistical Information System) updates and changes required by CMS (4%).
- Research, interpret, and ensure application of HHS/CMS rules and regulations to maintain ongoing compliance with Indiana Medicaid/Medicare systems (7%).
- Coordinate with the State Board of Accounts (SBOA) to design and deliver customized annual data extracts for audits and financial reporting, using automated workflows and secure transmission processes (4%).
- Remote work requests will be considered consistent with company's remote work policy.
- Domestic travel required less than 2% of the time.
Requirements
This position requires a:
- Bachelor's degree in Computer Science, Information Systems, Systems Engineering, or a related field, or foreign equivalent
- 7 years of relevant experience in data analysis, systems analysis, quality assurance, and CMS data reporting and compliance in the Business Systems Analyst or relevant position
This position also requires:
- 7 years of experience with handling multiple projects/workstreams simultaneously
- 7 years of experience defining and executing test strategies, UAT, and QA methodologies
- 7 years of experience with Agile and Waterfall software development methodologies
- 7 years of experience using JIRA, Zephyr, and comparable tools for project tracking and test management
- 7 years of experience in SQL and Teradata for data extraction, modeling, and validation
- 7 years of experience developing data dashboards and analytical reports using Tableau and comparable BI tools
- 5 years of experience utilizing data quality frameworks and data governance best practices
- 5 years of experience with Medicaid including CMS reporting compliance experience.
- Will accept any suitable combination of education, training, and experience.
