Principal Analyst, Medicaid Policy Analysis

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

📋 Description

• Interpret regulations from state and federal Medicaid programs, including eligibility criteria, aid-code structures, benefit designs, and program guidance.

• Convert policy documents into clear, testable analytical logic, which includes cohort definitions, code sets, exclusions, and stratification criteria.

• Ensure that interpretations are documented for audit purposes.

• Provide counsel to senior customer leadership regarding data limitations, measurable definitions, volumes, thresholds, caseloads, costs, and provider capacity.

• Anticipate the impact of policy changes on data and future inquiries.

• Develop member and provider data marts, cohort logic, stratification criteria, and registry extracts utilizing SQL and Python on Foundry and Redshift/Athena.

• Produce dashboards, recurring reports, Excel outputs, and presentations for leadership.

• Identify root causes of data quality issues and reconcile discrepancies across sources.

• Act as the primary analytical voice for state program leadership, policy and data staff, prime contractors, and vendor partners.

• Establish priorities, scope, and timelines in collaboration with Customer Management.

• Create leadership summaries, methodology decks, decision memos, and technical explanations for clients.

• Manage day-to-day analytic workflows, customer interactions, request prioritization, and ad hoc inquiries.

• Oversee production-grade registries, data marts, and dashboards with well-documented methodologies and data dictionaries.

• Mentor junior analysts and assist them in getting up to speed.

• Review significant deliverables, codify best practices, and set methodology standards.

⛳️ Requirements

• Proficient understanding of health programs and managed care plans.

• Capability to translate policy documents and program rules into analytical logic.

• Fluency in clinical codes and claims, including ICD-10, CPT/HCPCS, and revenue codes.

• Experience with claims, eligibility, and provider/NPI data, including NPPES and enrollment files.

• Proficient in AI coding and analysis tools such as Claude Code, Cursor, or similar applications.

• Advanced SQL skills, including CTEs, window functions, and performance optimization on extensive claims and eligibility tables.

• Data modeling expertise to engineering standards.

• Practical experience constructing dashboards and reports in QuickSight, Power BI, Tableau, and Excel.

• Ability to create executive-ready presentation decks.

• Direct experience engaging with senior stakeholders in a customer-facing role.

• Proven ability to scope ambiguous requests, manage competing priorities, and apply analytical judgment.

• Demonstrated record of leading an analytical program from start to finish for senior clients or executive audiences.

• Sound judgment in handling sensitive data and PHI.

• Experience with a state Medicaid agency, a Medicaid-serving prime contractor or consultancy, or a Medicaid managed care plan is advantageous.

• Familiarity with California Medi-Cal is a plus.

• Understanding of population health concepts, including risk stratification, registries, care management, network adequacy, and access and equity analysis.

• Experience with Python and dbt is preferred.

• Knowledge of AWS analytics tools such as Athena, Redshift, and QuickSight.

• Comfort with orchestration tools, Jira, Confluence, and GitHub-based workflows.

• Experience in mentoring less experienced analysts.

🏝️ Benefits

• Employee-led programs and initiatives for personal and professional growth.

• Flexible, remote-friendly work environment.

• Unlimited flexible time off (FTO).

• Competitive salary and compensation package.

• Comprehensive benefits.

• Opportunity to contribute to a high-visibility state Medicaid program that serves millions of members.

• Chance to develop methodology standards, playbooks, and data assets.