Data Analyst with Medicaid or Claims

Job Description

Job Description

Job Description:

1) Analyze Medicaid claims, eligibility, provider, and encounter data to identify trends, anomalies, and opportunities for improvement.
2) Support program evaluation, policy analysis, and operational decision-making through data insights.
3) Design and maintain dashboards and reports using tools like Power BI or Tableau. Present findings to stakeholders in a clear, actionable format.
4) Work with internal teams, external partners, and leadership to define data needs and deliver solutions. Present findings to stakeholders in a clear, actionable format.
5) Ensure all work aligns with Agencys regulations, including HIPAA and state data governance standards. Document methodologies, data sources, and assumptions for transparency and reproducibility.
6) Support special projects, audits, and federal reporting initiatives as needed.
7) Assist in the development of technical documentation for recurring reports, data pipelines, and reporting logic to ensure consistency and knowledge transfer.
8) Develop and validate data extracts for federal and state reporting requirements, including CMS submissions and performance metrics.
9) Apply machine learning methods where appropriate to improve forecasting and risk stratification models.
10) Perform other duties as required.
Required Qualifications:
a) Bachelors or masters degree in data science, Statistics, Computer Science, or a related field.
b) Five (5) or more years of experience in data analysis, preferably in healthcare or Medicaid.
c) Strong proficiency in SQL/SAS, with working knowledge of Python for data manipulation, analysis, and automation tasks.
d) Three (3) years of experience with data visualization tools such as Power BI, Tableau, or similar platforms for building dashboards and reports.
e) Strong understanding of healthcare data, especially Medicaid or claims-based data.
f) Excellent communication skills and ability to present complex data to non- technical audiences.

Preferred Qualifications

a) Experience working with state or federal healthcare programs.
b) Knowledge of Medicaid managed care, long-term services and support s(LTSS), or waiver programs.
c) Familiarity with cloud-based data platforms (e.g., Azure, AWS).
d) Experience with machine learning or advanced statistical modeling.