EDW Senior Healthcare Business/Data Analyst (Medicaid Reporting)

Clover Consulting has a direct client in Springfield, IL in need of an Enterprise Data Warehouse Senior Healthcare Business/Data Analyst (Medicaid Reporting) for a 12+ months contract. Job details are below.

Enterprise Data Warehouse Senior Healthcare Business/Data Analyst (Medicaid Reporting)

Role: EDW Senior Healthcare Business/Data Analyst (Medicaid Reporting)

Location: Remote - occasional travel to Illinois possible

Term: 12+ months contract, extensions possible

Rate: $52 W2 - $62 C2C

Functional Description

The Senior Business/Data Analyst supports the State Medicaid Enterprise Data Warehouse (EDW) and works closely with the Medicaid SME on federal and State reporting. The role owns core BA work with limited supervision: gathering and managing requirements, documenting business rules and processes, facilitating and documenting meetings, and tracking decisions and action items. The analyst also does hands-on data analysis in SQL to validate requirements, research data questions, and support testing of reports.

This role helps the SME focus on policy and leadership-level work by owning the day-to-day documentation, coordination, and analysis that keep reporting deliverables moving. It also builds backup knowledge on the team for Medicaid and federal reporting processes.

Primary Responsibilities

• Gather, document, and manage business requirements for EDW reports, extracts, and enhancements, including federal reporting such as CMS-64/CMS-21 support, MARS, T-MSIS, and PERM.
• Analyze current business processes and systems and document requirements for new or changed processes.
• Help translate federal and State Medicaid policy and reporting guidance into business rules and requirements, with direction from the Medicaid SME.
• Write clear requirements artifacts: business requirements, business rules, use cases, user stories, acceptance criteria, data mappings, and process flows.
• Maintain requirements traceability from request through design, testing, and delivery.
• Schedule and facilitate working sessions with State business users, Optum technical teams, and other partners. Capture minutes, decisions, action items, and follow-ups.
• Track open questions, dependencies, and risks for assigned work, and elevate issues to the SME and project lead when needed.
• Write SQL to profile and analyze Medicaid enrollment, eligibility, provider, claims, encounter, and financial data to answer business questions and confirm requirements.
• Identify and document data anomalies and report variances, and work with ETL, BI, and QA teams to resolve them.
• Share use cases with data and quality analysts for profiling, review results, and confirm alignment with project requirements and Medicaid/CMS guidelines.
• Support testing and UAT, including test scenarios, acceptance criteria, defect reporting, and follow-up.
• Prepare presentations, summaries, and status updates for the SME, internal leadership, and the customer.
• Maintain business documentation, data definitions, the Operations Guide, and related process documentation in SharePoint and Azure DevOps.
• Support end-user training and training materials related to reports and data.
• Mentor junior analysts and serve as backup to the Medicaid SME on day-to-day business questions and reporting processes.
• Peer review project artifacts and help manage intake and change requests, including impact analysis and BA effort estimates.
• Other duties consistent with the role, as assigned.

Required Qualifications

• Bachelor's degree in business, information systems, public health, or a related field, or equivalent experience.
• 8+ years of business analysis experience, including requirements gathering, documentation, stakeholder facilitation, and user acceptance testing.
• 5+ years of experience working with healthcare data such as claims, encounters, eligibility/enrollment, provider, or financial data.
• 3+ years of experience with Medicaid or public-sector healthcare programs, such as State Medicaid/CHIP agencies, MMIS/MES vendors, Medicaid data warehouses, or Medicaid managed care plans.
• 3+ years of experience writing SQL to analyze and validate data in a relational database or data warehouse.
• Understanding of Fee for Service and managed care claim adjudication, from eligibility and enrollment through claims processing to funding/finance, including managed care encounters.
• Basic understanding of CMS reporting requirements for Medicaid.
• Experience writing use cases, user stories, and acceptance criteria and supporting testing/UAT.
• Experience facilitating meetings and documenting outcomes.
• Proficient in MS Word, Excel, PowerPoint, Visio, MS Project, SharePoint, and Teams.
• Strong written and verbal communication skills, with the ability to explain data findings to both technical and non-technical audiences.
• Self-starter who is organized and detail-oriented, and able to manage competing priorities and tight deadlines with limited supervision.
• Ability to travel to Springfield, IL up to three (3) times per year or as needed.

Note: Core customer business hours are M-F 8 AM to 5 PM CST.

Preferred Qualifications

• Experience with CMS federal reporting such as CMS-64/CMS-21, MARS, T-MSIS, PERM, or similar projects.
• Knowledge of quality measures such as CMS Core Set, HEDIS, or CHIPRA.
• Knowledge of health insurance, HMO, and managed care principles, including Medicaid and Medicare regulation, the Affordable Care Act, and eligibility.
• Experience on a Medicaid Enterprise System (MES)/MMIS or Enterprise Data Warehouse DDI project.
• Experience with Teradata and SQL Assistant/Query Studio, Business Objects, Tableau, or Power BI.
• Familiarity with ETL and reporting processes.
• Experience with knowledge management tools such as Microsoft 365, SharePoint/Teams, and AI-enabled search.
• Experience with Azure DevOps or JIRA, and Agile/Scrum projects.
• CBAP, CCBA, or PMI-PBA certification.