Medicaid Program Integrity Jobs in Dallas, TX (NOW HIRING)

Role: EDW Medicaid Subject Matter Expert/Data Specialist (Federal Reporting Porject)

Must be a US Citizen

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.

Functional Description:

This position is a Medicaid Subject Matter (SME) 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 warehousing or decision support systems. This role provides the guidance and direction to support a large data warehouse implementation and maintenance & 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.

Required Qualifications:

• More than ten (10) years of experience in information technology with five (5) years of experience working directly with/for State Medicaid agencies or equivalent supporting business initiatives through data analysis, writing business requirements and testing/validation of various systems.

• More than five (5) years of experience serving as the subject matter expert for CMS and State Medicaid federal reporting, including T-MSIS, PERM, MARS, and other CMS-mandated submissions, ensuring data accuracy, compliance, and audit readiness.

• Understanding of claims, recipient/eligibility, and provider/enrollment data processes.

• Advanced SQL proficiency with over 5 years of experience analyzing large Medicaid data sets (claims, eligibility, provider, and federal extracts) within an EDW environment.

• Knowledge of the Centers for Medicare and Medicaid Services reporting requirements and the programs covered.

• Excellent verbal/written communication and presentation skills, manager/executive/director-level 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 two (3) to three (4) times per year.

Preferred Qualifications:

• More than 2 years of experience in HEDIS, CHIPRA or similar quality metrics

• 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.

• Good to be located within driving distance (3 - 5 Hours) of Springfield, IL.

This is a remote position.