Medicaid Business/QA Analyst

Key Responsibilities: Business SME - Medicaid Data & ProcessesInterpret Medicaid data elements, business rules, and program logic for EDW initiatives. Review inbound data from core systems (eligibility, provider, claims, managed care) for accuracy and mapping alignment. Validate outbound extracts and reporting outputs for accuracy, timeliness, and format requirements. Support development of data marts across eligibility, claims/utilization, provider, managed care, LTSS, and behavioral health. QA Planning & ExecutionDevelop QA plans, scenarios, and test cases aligned to business rules. Perform data reconciliation between source files and EDW target tables. Validate transformations, aggregations, and derived fields. Participate in User Acceptance Testing (UAT) with business stakeholders. Data Quality & Issue ResolutionIdentify data anomalies, mapping issues, and business rule gaps; work with data engineering and ETL teams to resolve. Ensure referential integrity across eligibility, claims, provider, and plan datasets. Define business data quality rules for ongoing monitoring. Track and document issues in defect management tools. Collaboration & DocumentationWork with business stakeholders, vendors, and technical teams to validate requirements and deliverables. Review BRDs, mapping documentation, and data models for accuracy. Maintain QA evidence, testing documentation, and business rule records. Support knowledge transfer related to Medicaid data usage within the EDW. Required Skills & QualificationsStrong Medicaid business knowledge (eligibility, claims, encounters, provider, managed care). Experience working with EDW environments, including inbound feeds, staging layers, integration layers, data marts, and outbound extracts. Proficiency with SQL for validation and reconciliation. Experience in data warehouse QA/testing, including validating data transformations and dimensional models. Ability to translate Medicaid program rules into testable acceptance criteria. Familiarity with HIPAA compliance and PHI guidelines. Excellent analytical, documentation, and communication skills.

Preferred Qualifications: Experience with Medicaid EDW or MMIS modernization projects. Familiarity with provider handbooks, policy documentation, or administrative rules. Experience with managed care data (capitation, encounters, member assignments). Experience validating dashboards or reports in tools such as Tableau, Power BI, or Cognos. Background in data governance or metadata management.