Medicaid Business/QA Analyst
Core
Subject matter expert on Medicaid data and processes performing quality assurance in a large-scale enterprise data warehouse environment to ensure accuracy, completeness, and usability of data deliverables.
Role type
Medicaid Business/QA Analyst
Builds
Data marts, source data loads, extracts, reports, and operational dashboards covering eligibility, claims, providers, managed care, LTSS, and behavioral health.
Domain
Healthcare / Medicaid / Data Warehousing
Required skills
Medicaid eligibility, claims, encounters, provider programs, managed care, EDW environments, SQL, data validation, reconciliation, QA testing, transformation validation, dimensional model validation, HIPAA compliance, PHI guidelines, data governance, metadata management
Preferred skills
State Medicaid program experience, Medicaid EDW or MMIS modernization projects, provider handbooks/policy documents, managed care data (capitation, encounters, member assignments), dashboard validation (Tableau, Power BI, Cognos)
Technologies
SQL, Power BI, Tableau, Data Warehouse ETL
Responsibilities
Interpret Medicaid data elements, business rules, and program logic for EDW initiatives; Review inbound data from eligibility, provider, claims, and managed care systems for accuracy and mapping alignment; Validate outbound extracts and reporting outputs for accuracy, timeliness, and required formats; Create QA plans, scenarios, and test cases based on business rules; Reconcile source files with EDW target tables and validate transformations, aggregations, and derived fields; Participate in user acceptance testing with business stakeholders; Identify data anomalies, mapping problems, and business rule gaps, and coordinate resolution with data engineering and ETL teams; Check referential integrity across eligibility, claims, provider, and plan datasets; Define business data quality rules for ongoing monitoring; Track and document defects using issue management tools; Collaborate with business stakeholders, vendors, and technical teams to validate requirements and deliverables; Review business requirements documents, mapping documentation, and data models for accuracy; Maintain QA evidence, testing documentation, and business rule records; Support knowledge transfer on Medicaid data use within the EDW