Medicaid Data Specialist (Federal Reporting)
Description:
At CSpring, we believe in the power of people and data to drive real-world impact. We’re a purpose-driven consulting firm that helps organizations solve complex problems, gain insights, and achieve measurable results. Our clients span the public and private sectors, and our work — from data strategy and engineering to workforce transformation — improves lives across Indiana and beyond. We’re seeking talented professionals who are collaborative, curious, and committed to making a difference.
Why You’ll Love Working Here
• Work that matters at scale. The decisions you make here affect how Illinois manages its Medicaid program — data quality, compliance, and reporting accuracy have direct downstream impact on the people the state serves.
• A team that trusts your expertise. At CSpring, SMEs aren't just consulted — they're the ones who move things forward. You'll provide real direction to both technical and business teams, not just recommendations that get ignored.
• Deep, interesting problems. Claims adjudication, recipient eligibility, provider enrollment, federal extract integrity — this work is substantive, and you'll be solving problems that don't have easy answers.
• A culture that's warm and grounded. CSpring is a firm where people know each other and look out for each other. Collaboration isn't a value on a poster — it's how the work actually gets done.
What You’ll Do
As the EDW Medicaid SME, you'll be the authoritative voice on Medicaid data and federal reporting for a major state implementation — guiding decisions, validating solutions, and keeping the work grounded in what Medicaid programs actually need.
• Provide direction, guidance, and recommendations supporting decision-making for a large Medicaid data warehouse implementation and ongoing operations.
• Lead and guide internal and external stakeholders through complex determinations involving claims processing and adjudication, recipient and provider eligibility, and third-party liability.
• Proactively identify state Medicaid agency data needs and recommend solutions backed by credible justification and validated proof of concepts.
• Direct technical and business teams on healthcare data topics, ensuring Medicaid data is understood and used appropriately across the project.
• Serve as the subject matter expert for CMS and state federal reporting requirements, including T-MSIS, PERM, MARS, and other CMS-mandated submissions — ensuring data accuracy, compliance, and audit readiness.
• Analyze large Medicaid data sets (claims, eligibility, provider, and federal extracts) using advanced SQL within an EDW environment.
• Partner with stakeholders to understand data requirements and support development of interfaces, dashboards, data visualizations, and decision aids.
• Produce and manage the delivery of activity reports, value analytics, and critical deliverables to external stakeholders and clients.
• Proactively recommend enhancements and process improvements driven by Medicaid best practices, standards, and policies.
• Travel to Springfield, IL approximately three to four times per year for onsite client meetings.
Requirements:
• 10+ years of experience in information technology, with at least 5 years working directly with or for state Medicaid agencies, supporting business initiatives through data analysis, business requirements writing, and system testing and validation.
• 5+ years as a subject matter expert for CMS and state Medicaid federal reporting — including T-MSIS, PERM, MARS, and other mandated submissions — with demonstrated focus on data accuracy, compliance, and audit readiness.
• Solid understanding of claims processing and adjudication, recipient/eligibility data, and provider/enrollment data processes.
• Advanced SQL proficiency, with 5+ years analyzing large Medicaid data sets (claims, eligibility, provider, federal extracts) in an Enterprise Data Warehouse environment.
• Working knowledge of CMS reporting requirements and the programs they cover.
• Strong verbal and written communication skills, with the ability to present to and collaborate with managers, executives, and director-level clients.
• Ability to travel to Springfield, IL three to four times per year.
Preferred Qualifications
• 2+ years of experience with HEDIS, CHIPRA, or similar quality metrics.
• Experience with Teradata or an equivalent enterprise database management system.
• Familiarity with JIRA, Rally, Azure DevOps, or equivalent project tracking tools.
• Prior experience on a large-scale Medicaid system implementation project.
• Located within a 3–5 hour drive of Springfield, IL.
At CSpring, we unlock the potential of people and data. If you’re ready to lead meaningful work, collaborate with passionate teams, and grow your career in a people-first consulting environment — apply today!
Apply tot his job
Apply To this Job
At CSpring, we believe in the power of people and data to drive real-world impact. We’re a purpose-driven consulting firm that helps organizations solve complex problems, gain insights, and achieve measurable results. Our clients span the public and private sectors, and our work — from data strategy and engineering to workforce transformation — improves lives across Indiana and beyond. We’re seeking talented professionals who are collaborative, curious, and committed to making a difference.
Why You’ll Love Working Here
• Work that matters at scale. The decisions you make here affect how Illinois manages its Medicaid program — data quality, compliance, and reporting accuracy have direct downstream impact on the people the state serves.
• A team that trusts your expertise. At CSpring, SMEs aren't just consulted — they're the ones who move things forward. You'll provide real direction to both technical and business teams, not just recommendations that get ignored.
• Deep, interesting problems. Claims adjudication, recipient eligibility, provider enrollment, federal extract integrity — this work is substantive, and you'll be solving problems that don't have easy answers.
• A culture that's warm and grounded. CSpring is a firm where people know each other and look out for each other. Collaboration isn't a value on a poster — it's how the work actually gets done.
What You’ll Do
As the EDW Medicaid SME, you'll be the authoritative voice on Medicaid data and federal reporting for a major state implementation — guiding decisions, validating solutions, and keeping the work grounded in what Medicaid programs actually need.
• Provide direction, guidance, and recommendations supporting decision-making for a large Medicaid data warehouse implementation and ongoing operations.
• Lead and guide internal and external stakeholders through complex determinations involving claims processing and adjudication, recipient and provider eligibility, and third-party liability.
• Proactively identify state Medicaid agency data needs and recommend solutions backed by credible justification and validated proof of concepts.
• Direct technical and business teams on healthcare data topics, ensuring Medicaid data is understood and used appropriately across the project.
• Serve as the subject matter expert for CMS and state federal reporting requirements, including T-MSIS, PERM, MARS, and other CMS-mandated submissions — ensuring data accuracy, compliance, and audit readiness.
• Analyze large Medicaid data sets (claims, eligibility, provider, and federal extracts) using advanced SQL within an EDW environment.
• Partner with stakeholders to understand data requirements and support development of interfaces, dashboards, data visualizations, and decision aids.
• Produce and manage the delivery of activity reports, value analytics, and critical deliverables to external stakeholders and clients.
• Proactively recommend enhancements and process improvements driven by Medicaid best practices, standards, and policies.
• Travel to Springfield, IL approximately three to four times per year for onsite client meetings.
Requirements:
• 10+ years of experience in information technology, with at least 5 years working directly with or for state Medicaid agencies, supporting business initiatives through data analysis, business requirements writing, and system testing and validation.
• 5+ years as a subject matter expert for CMS and state Medicaid federal reporting — including T-MSIS, PERM, MARS, and other mandated submissions — with demonstrated focus on data accuracy, compliance, and audit readiness.
• Solid understanding of claims processing and adjudication, recipient/eligibility data, and provider/enrollment data processes.
• Advanced SQL proficiency, with 5+ years analyzing large Medicaid data sets (claims, eligibility, provider, federal extracts) in an Enterprise Data Warehouse environment.
• Working knowledge of CMS reporting requirements and the programs they cover.
• Strong verbal and written communication skills, with the ability to present to and collaborate with managers, executives, and director-level clients.
• Ability to travel to Springfield, IL three to four times per year.
Preferred Qualifications
• 2+ years of experience with HEDIS, CHIPRA, or similar quality metrics.
• Experience with Teradata or an equivalent enterprise database management system.
• Familiarity with JIRA, Rally, Azure DevOps, or equivalent project tracking tools.
• Prior experience on a large-scale Medicaid system implementation project.
• Located within a 3–5 hour drive of Springfield, IL.
At CSpring, we unlock the potential of people and data. If you’re ready to lead meaningful work, collaborate with passionate teams, and grow your career in a people-first consulting environment — apply today!
Apply tot his job
Apply To this Job