Medicaid Business/QA Analyst

Medicaid Business / QA Analyst

• 7-12+ Month Contract | Remote | No Third-Party Firms | Medicaid SME Required
• Candidates with previous State Medicaid program experience will be given strong consideration.
• Drug screen and background check required as part of onboarding

Position Summary

The Medicaid Business/QA Analyst serves as a subject matter expert (SME) for Medicaid data and processes while performing quality assurance testing within a large-scale Enterprise Data Warehouse (EDW) environment. This position combines program knowledge-eligibility, claims, encounters, provider enrollment, managed care, and reporting-with QA discipline to ensure accuracy, completeness, and usability of EDW deliverables such as data marts, inbound source data loads, outbound extracts, reporting outputs, and operational dashboards.

Key Responsibilities

1. Business SME - Medicaid Data & Processes

• Interpret Medicaid data elements, business rules, and program logic for EDW initiatives.
• Review inbound data from core systems (eligibility, provider, claims, managed care) for accuracy and mapping alignment.
• Validate outbound extracts and reporting outputs for accuracy, timeliness, and format requirements.
• Support development of data marts across eligibility, claims/utilization, provider, managed care, LTSS, and behavioral health.

2. QA Planning & Execution

• Develop QA plans, scenarios, and test cases aligned to business rules.
• Perform data reconciliation between source files and EDW target tables.
• Validate transformations, aggregations, and derived fields.
• Participate in User Acceptance Testing (UAT) with business stakeholders.

3. Data Quality & Issue Resolution

• Identify data anomalies, mapping issues, and business rule gaps; work with data engineering and ETL teams to resolve.
• Ensure referential integrity across eligibility, claims, provider, and plan datasets.
• Define business data quality rules for ongoing monitoring.
• Track and document issues in defect management tools.

4. Collaboration & Documentation

• Work with business stakeholders, vendors, and technical teams to validate requirements and deliverables.
• Review BRDs, mapping documentation, and data models for accuracy.
• Maintain QA evidence, testing documentation, and business rule records.
• Support knowledge transfer related to Medicaid data usage within the EDW.

Required Skills & Qualifications

• Strong Medicaid business knowledge (eligibility, claims, encounters, provider, managed care).
• Experience working with EDW environments, including inbound feeds, staging layers, integration layers, data marts, and outbound extracts.
• Proficiency with SQL for validation and reconciliation.
• Experience in data warehouse QA/testing, including validating data transformations and dimensional models.
• Ability to translate Medicaid program rules into testable acceptance criteria.
• Familiarity with HIPAA compliance and PHI guidelines.
• Excellent analytical, documentation, and communication skills.

Preferred Qualifications

• Experience with Medicaid EDW or MMIS modernization projects.
• Familiarity with provider handbooks, policy documentation, or administrative rules.
• Experience with managed care data (capitation, encounters, member assignments).
• Experience validating dashboards or reports in tools such as Tableau, Power BI, or Cognos.
• Background in data governance or metadata management.