[Hiring] Senior Data Analyst @CLOUDSCOUTS SOFTWARE SOLUTIONS LLC

Role Description

• Analyze large volumes of Medicaid healthcare data, including claims, enrollment, provider, eligibility, encounter, and pharmacy data.
• Gather, analyze, and document business and data requirements from Medicaid business stakeholders.
• Develop and maintain complex SQL queries, stored procedures, and data validation scripts for data extraction and analysis.
• Perform detailed analysis of Medicaid claims adjudication, member eligibility, provider networks, and reimbursement processes.
• Design, develop, and maintain dashboards, scorecards, and reports using BI tools such as Tableau, Power BI, or Cognos.
• Conduct data profiling, data quality assessments, and root cause analysis to ensure accuracy and completeness of Medicaid data.
• Collaborate with business teams to support Medicaid regulatory reporting, including CMS, state-specific mandates, and quality measures.
• Analyze healthcare KPIs, utilization trends, cost containment opportunities, and operational metrics.
• Support Medicaid programs such as Managed Care, Fee-for-Service (FFS), Dual Eligible, LTSS, and Value-Based Care initiatives.
• Work closely with ETL and data engineering teams to validate source-to-target mappings and data transformations.
• Perform impact analysis for system enhancements, regulatory changes, and Medicaid policy updates.
• Create functional specifications, business requirement documents (BRDs), and data mapping documents.
• Participate in Agile ceremonies including sprint planning, backlog grooming, daily stand-ups, and retrospectives.
• Ensure compliance with HIPAA regulations and healthcare data security standards.
• Provide mentorship and guidance to junior analysts and team members.

Qualifications

• Strong experience in Medicaid programs and healthcare payer systems.
• Deep understanding of Medicaid claims processing lifecycle.
• Experience with:
  • Member Eligibility and Enrollment
  • Claims Adjudication
  • Provider Management
  • Encounters and Capitation
  • Prior Authorization
  • Care Management
  • Pharmacy and PBM data
  • ICD-10, CPT, HCPCS, DRG, NDC coding systems
  • CMS and State Medicaid reporting

Requirements

• 10+ Years of experience.

Company Description