Senior Medicaid Data SME – EDW (SQL / Analytics)
Senior Medicaid Data SME – EDW (SQL / Analytics) Remote Contract | Limited Travel Duration: Long‑term contract (extensions expected based on performance) Work Location: 100% Remote Travel: Less than 25%; 2–4 onsite visits per year to Springfield, IL (as needed)
Benefits
Available: Medical, Dental, Vision Not Open to Third Party Firms We are seeking a Senior Medicaid Data Subject Matter Expert (SME) to support a large‑scale Enterprise Data Warehouse (EDW) and analytics environment for a state Medicaid program. This role supports both system implementation (DDI) and ongoing maintenance and operations, and requires a strong blend of Medicaid domain expertise and hands‑on data analysis skills. This is a working SME role. The ideal candidate understands Medicaid and CHIP data end‑to‑end and is comfortable using SQL directly to analyze, validate, reconcile, and troubleshoot data used for state and federal reporting. The SME will guide business and technical teams through complex data decisions related to claims, eligibility, providers, and regulatory reporting.
Key Responsibilities
Provide direction, guidance, and recommendations supporting decision‑making for Medicaid EDW implementation and operations Serve as a subject‑matter authority on Medicaid and CHIP programs, advising stakeholders on complex data processes including:
- Claims processing and adjudication
- Recipient eligibility
- Provider enrollment
- Third‑party liability
- Use SQL as a primary tool to analyze, validate, and reconcile Medicaid data within large enterprise data warehouse environments
- Perform hands‑on data investigation to support CMS reporting, audit readiness, issue resolution, and data quality efforts
- Identify state Medicaid agency data needs and recommend data‑driven solutions supported by analysis and clear justification
- Support data validation, root‑cause analysis, and troubleshooting related to claims, eligibility, and provider datasets
- Guide technical and business teams on appropriate interpretation and use of healthcare data
- Recommend enhancements and process improvements aligned with CMS guidance, Medicaid policies, and industry best practices
- Partner with stakeholders to define data requirements and support deliverables such as reports, dashboards, visualizations, decision aids, and business case analysis
- Produce and manage analytics outputs and supporting documentation used by state and federal stakeholders
Required Qualifications
- 10+ years of IT or data experience, including 5+ years working directly with or for State Medicaid agencies (or equivalent)
- Experience supporting business initiatives through data analysis, business requirements development, and system testing or validation
- 2+ years of experience supporting CMS Federal Reporting, including:
- Experience with: MARS, PERM and T‑MSIS
- Quality of Care / CMS Core Measures
- Strong understanding of Medicaid claims, eligibility, and provider enrollment data processes
- Strong hands‑on SQL experience, including writing and executing queries against large enterprise data warehouses to analyze and validate data
- Experience using SQL and Excel for data reconciliation, investigation, and issue resolution
- Knowledge of CMS reporting requirements and Medicaid program structures
- Strong verbal and written communication skills, with the ability to work directly with manager‑, director‑, and executive‑level stakeholders
Preferred Experience
- Prior experience supporting large Medicaid DDI implementations and post‑implementation operations
- Experience working with Teradata or similar enterprise data warehouse platforms
- Familiarity with JIRA, Rally, Azure DevOps, or similar issue‑tracking tools
- Experience producing analytics or reporting deliverables in regulated or public‑sector environments
- Located within 3–5 hours driving distance of Springfield, IL
Why This Opportunity
- Senior, high‑impact role supporting mission‑critical Medicaid programs
- Clear expectation of hands‑on SQL and data ownership
- Balance of strategic advisory work and direct data analysis
- Fully remote with limited, predictable travel
- Work in a highly regulated public‑sector data environment
- Contract benefits available (medical, dental, vision)