Business Data Analyst – Medicaid

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Collect, document, and oversee business requirements for EDW reports, extracts, and enhancements, including CMS-64/CMS-21, MARS, T-MSIS, and PERM support.

• Examine existing business processes and systems, and document requirements for any new or modified processes.

• Convert federal and State Medicaid policy and reporting guidelines into actionable business rules and requirements.

• Develop business requirements, business rules, use cases, user stories, acceptance criteria, data mappings, and process flows.

• Ensure requirements traceability throughout design, testing, and delivery phases.

• Lead working sessions with State business users, Optum technical teams, and other stakeholders.

• Document meeting minutes, decisions, action items, and follow-ups.

• Monitor questions, dependencies, and risks, escalating issues when necessary.

• Utilize SQL to profile and analyze Medicaid enrollment, eligibility, provider, claims, encounter, and financial data.

• Detect and document data anomalies and variances, collaborating with ETL, BI, and QA teams to resolve them.

• Share use cases with data and quality analysts, review profiling outcomes, and ensure alignment with requirements and Medicaid/CMS standards.

• Assist with testing and UAT, including developing test scenarios, acceptance criteria, defect reporting, and follow-ups.

• Create presentations, summaries, and status updates for leadership and clients.

• Maintain business documentation, data definitions, the Operations Guide, and process documentation in SharePoint and Azure DevOps.

• Aid in end-user training and the development of training materials.

• Mentor junior analysts and act as a backup for the Medicaid SME.

• Review project artifacts with peers and assist in managing intake and change requests, including impact analysis and business analyst effort estimates.

⛳️ Requirements

• Bachelor’s degree in business, information systems, public health, or a related field, or equivalent experience.

• Over 8 years of experience in business analysis, including gathering requirements, documentation, stakeholder facilitation, and user acceptance testing.

• At least 5 years of experience with healthcare data such as claims, encounters, eligibility/enrollment, provider, or financial data.

• Minimum of 3 years of experience with Medicaid or public-sector healthcare programs.

• At least 3 years of experience writing SQL for data analysis and validation in a relational database or data warehouse.

• Knowledge of Fee for Service and managed care claim adjudication.

• Basic understanding of CMS reporting requirements for Medicaid.

• Experience writing use cases, user stories, and acceptance criteria, as well as supporting testing/UAT.

• Proven experience facilitating meetings and documenting results.

• Proficient in MS Word, Excel, PowerPoint, Visio, MS Project, SharePoint, and Teams.

• Excellent written and verbal communication skills.

• Highly organized and detail-oriented, capable of managing competing priorities and tight deadlines with minimal supervision.

• Willingness to travel to Springfield, IL up to three times a year or as needed.

• Additional experience with CMS-64/CMS-21, MARS, T-MSIS, PERM, CMS Core Set, HEDIS, CHIPRA, Medicaid/Medicare regulations, ACA, MES/MMIS, Enterprise Data Warehouse DDI, Teradata, SQL Assistant/Query Studio, Business Objects, Tableau, Power BI, ETL, Microsoft 365, Azure DevOps, JIRA, Agile/Scrum, and CBAP, CCBA, or PMI-PBA certification is a plus.

🏝️ Benefits

• Engaging projects that enhance systems benefitting real individuals.

• A people-first culture that promotes support, autonomy, and community.

• Strategic, hands-on work opportunities.

• Collaborative engagement with clients and teams.

• Meaningful contributions and pathways for career advancement.

• Fully remote work arrangement.

• Travel to Springfield, IL up to three times a year or as needed.