Job Title: Senior Data Analyst – Medicaid Exp Must Experience : 10+ Years

Key Responsibilities: • Analyze large volumes of Medicaid healthcare data, including claims, enrollment, provider, eligibility, encounter, and pharmacy data. • Gather, analyze, and document business and data requirements from Medicaid business stakeholders. • Develop and maintain complex SQL queries, stored procedures, and data validation scripts for data extraction and analysis. • Perform detailed analysis of Medicaid claims adjudication, member eligibility, provider networks, and reimbursement processes. • Design, develop, and maintain dashboards, scorecards, and reports using BI tools such as Tableau, Power BI, or Cognos. • Conduct data profiling, data quality assessments, and root cause analysis to ensure accuracy and completeness of Medicaid data. • Collaborate with business teams to support Medicaid regulatory reporting, including CMS, state-specific mandates, and quality measures. • Analyze healthcare KPIs, utilization trends, cost containment opportunities, and operational metrics. • Support Medicaid programs such as Managed Care, Fee-for-Service (FFS), Dual Eligible, LTSS, and Value-Based Care initiatives. • Work closely with ETL and data engineering teams to validate source-to-target mappings and data transformations. • Perform impact analysis for system enhancements, regulatory changes, and Medicaid policy updates. • Create functional specifications, business requirement documents (BRDs), and data mapping documents. • Participate in Agile ceremonies including sprint planning, backlog grooming, daily stand-ups, and retrospectives. • Ensure compliance with HIPAA regulations and healthcare data security standards. • Provide mentorship and guidance to junior analysts and team members.

Required Skills: Healthcare/Medicaid Domain: • Strong experience in Medicaid programs and healthcare payer systems. • Deep understanding of Medicaid claims processing lifecycle. • Experience with: ○ Member Eligibility and Enrollment ○ Claims Adjudication ○ Provider Management ○ Encounters and Capitation ○ Prior Authorization ○ Care Management ○ Pharmacy and PBM data ○ ICD-10, CPT, HCPCS, DRG, NDC coding systems ○ CMS and State Medicaid reporting

This is a remote position.