Medicaid Data Warehouse and Encounter Claim Processing Transition Lead

Role Description

The Medicaid Data Warehouse and Encounter Claim Processing Transition Lead will be responsible for leading the successful transition of the state's Medicaid data warehouse and encounter processing solution to a state-run and managed model. This role will coordinate transition activities, including the development of key deliverables required for transition and sustainable ongoing operations. The Transition Lead will coordinate activities of a team of data and operational experts, collaborate with project management, and ensure that all transition goals align with state and federal requirements.

Job Responsibilities

• Transition Management:
  • Coordinate the transition of the Medicaid data warehouse and encounter claim processing solution from vendor management to a state-run model.
  • Oversee and manage a team responsible for technical and operational aspects of the transition and ongoing data warehouse operations.
  • Develop and author transition deliverables, including operational documentation, data migration plans, system integration strategies, and reporting requirements.
  • Develop and execute transition plans, including risk mitigation and knowledge transfer.
  • Document transition processes and manage transition readiness checklists.
• Operations Management:
  • Manage and oversee the daily operations of the Medicaid Data Warehouse, ensuring seamless functionality.
  • Monitor ETL processes, data pipelines, and system performance to prevent downtime and inefficiencies.
  • Establish and enforce operational procedures for data ingestion, validation, transformation, and reporting.
  • Collaborate with technical teams to implement automation, performance improvements, and scalability solutions.
  • Work closely with business users to understand reporting and data access needs.
• Team Leadership and Collaboration:
  • Lead and mentor a team of analysts, engineers, and support staff responsible for Medicaid Data Warehouse operations.
  • Serve as the primary liaison between IT, business stakeholders, and state Medicaid agencies.
  • Conduct regular meetings to provide updates on operational status, performance metrics, and transition progress.
• Issue Resolution and Support:
  • Lead troubleshooting and root cause analysis for operational issues, working with data engineers and support teams.
  • Establish and maintain SLAs for issue resolution and operational support.
  • Provide guidance to teams on resolving Medicaid data anomalies, claim processing errors, and eligibility discrepancies.
• Compliance and Security:
  • Ensure compliance with CMS (Centers for Medicare & Medicaid Services) regulations, HIPAA, and state Medicaid data governance policies.
  • Implement security protocols for data access, storage, and sharing in accordance with regulatory requirements.
  • Oversee audits and reporting processes to maintain data accuracy and integrity.

Qualifications

• 7+ years of experience in Medicaid data warehouse operations, transition projects, or healthcare data management.
• Experience in large-scale system transitions, implementations, or migrations in a government or healthcare setting.
• Strong leadership skills with the ability to manage cross-functional teams and complex projects.
• Deep understanding of Medicaid data structures, encounter processing, federal reporting requirements, and data governance.
• Foundational knowledge of ETL processes, cloud-based data warehouses (AWS, Azure, Snowflake), and SQL.
• Experience working with state Medicaid agencies or MMIS (Medicaid Management Information Systems).
• Strong technical writing skills with experience authoring operational documentation and transition plans.
• Ability to analyze and interpret complex healthcare data to drive informed decision-making.
• Familiarity with cloud-based data warehouse solutions and modern data processing tools.
• Strong knowledge of data security best practices and compliance requirements, including HIPAA.

Preferred Credentials and Experience

• Experience with Medicaid Enterprise Systems (MES) modernization efforts.
• Prior experience working with CMS (Centers for Medicare & Medicaid Services) on Medicaid data initiatives.

Benefits

This role is an excellent opportunity for a seasoned Medicaid data expert who is eager to lead a high-impact transition and contribute to the long-term success of a state-run Medicaid data warehouse. If you have the required experience and leadership capabilities, we encourage you to apply.