Business Data Analyst - Medicaid

About CSpring

Role overview

Responsibilities

• Gather and manage requirements for Medicaid EDW reports, extracts, and enhancements, including federal reporting support for CMS-64/CMS-21, MARS, T-MSIS, and PERM.
• Analyze processes and systems; translate federal and state Medicaid guidance into business rules and requirements with SME guidance.
• Produce business requirements, rules, use cases, user stories, acceptance criteria, data mappings, and process flows; maintain traceability through delivery.
• Facilitate working sessions with state business users, Optum technical teams, and partners; record decisions, action items, and follow-ups.
• Track open questions, dependencies, and risks; escalate issues to the SME and project lead as needed.
• Use SQL to profile Medicaid enrollment, eligibility, provider, claims, encounter, and financial data; identify anomalies and variances and coordinate resolution with ETL, BI, and QA teams.
• Share use cases with data and quality analysts, review results, and confirm alignment with project and Medicaid/CMS requirements.
• Support testing and UAT with test scenarios, acceptance criteria, defect reporting, and follow-up.
• Prepare presentations, summaries, and status updates; maintain data definitions, the Operations Guide, and process documentation in SharePoint and Azure DevOps.
• Support end-user training, peer review, intake and change requests, impact analysis, effort estimates, and day-to-day coverage for the Medicaid SME; mentor junior analysts.

Qualifications

• Bachelor's degree in business, information systems, public health, or a related field, or equivalent experience.
• At least eight years of business analysis experience, including requirements, documentation, stakeholder facilitation, and UAT.
• At least five years working with healthcare data, including claims, encounters, eligibility/enrollment, provider, or financial data.
• At least three years working with Medicaid or public-sector healthcare programs, such as state Medicaid/CHIP agencies, MMIS/MES vendors, Medicaid data warehouses, or managed care plans.
• At least three years writing SQL to analyze and validate relational database or data warehouse data.
• Understand Fee for Service and managed care claim adjudication, including eligibility, enrollment, claims processing, funding, and managed care encounters.
• Have a basic understanding of CMS Medicaid reporting requirements and experience writing use cases, user stories, acceptance criteria, and supporting testing/UAT.
• Have experience facilitating meetings and documenting outcomes; be proficient in Word, Excel, PowerPoint, Visio, MS Project, SharePoint, and Teams.
• Strong written and verbal communication skills are requested; the description ends during this qualification.