Company Description
CNSI delivers a broad range of health information technology enterprise solutions and customizable products to a diverse base of state and federal agencies. We align, build, and manage innovative, high-quality, cost-effective solutions that help customers achieve their mission, enhance business performance, reduce costs, and improve health for over 51 million Americans.
Job Description
Summary:
The Senior Healthcare Federal Reporting Specialist – Medicaid is responsible for analyzing business problems, identifying gaps, and developing solutions involving complex information systems under no supervision relates to CMS reporting requirements for Medicaid, Claims, Benefits Administration, Member Eligibility, Provider Enrollment, Prior Authorization, Third Party Liability (TPL) and Contracts Managed Care. This role involves managing requirement scope, determining appropriate methods on potential assignments, and serving as a bridge between information technology teams and the client through all project phases, providing day-to-day direction on State program activities.
Job Responsibilities:
- Provides Medicaid and Children’s Health Insurance Program (CHIP) expertise and guidance as it relates to Expenditures Reports, Federal Compliance Reports, Management, Analysis and Reporting Subsystem (MARS), Surveillance and Utilization Review Subsystem (SURS) reports
- Analyzes user requirements and client business needs, leveraging expert opinion and expertise
- Share use cases to data analysts for profiling, review results, and infer compliance to Medicaid / CMS processes and guidelines
- Acts as the requirements subject matter expert and supports requirements change management
- Works with customers on presenting technical solutions for complex business functionalities
- Understand the overall system architecture and cross-functional integration
- Demonstrates in-depth knowledge of business analysis to ensure high quality
- Communicates issues and risks to the manager or direct supervisor and assists in developing solutions
The selected candidate will be able to work remotely in the U.S. with up to 50% travel for client and team meetings, and trainings. Candidate located in the Atlanta, Georgia area preferred.
Qualifications
Required Experience/Skills:
- Bachelors’ Degree with 7+ years of healthcare data analysis experience and writing business requirements OR Master’s Degree with 5+ years of healthcare data analysis experience and writing business requirements.
- 4+ years of experience in working with State Medicaid and CHIP agencies.
- 3+ years of experience working with PERM, T-MSIS, CMS Federal Reporting, or similar projects.
- 2+ years of experience in HEDIS, CHIPRA, or similar quality metrics.
- In-depth knowledge of CMS reporting requirements for Medicaid.
- In-depth understanding of FFS, Managed Care claim adjudication processes from enrollment to funding/finance.
- Knowledge of the Affordable Care Act and eligibility.
- Able to perform complex data analysis using SQL, Excel against data warehouses utilizing large datasets.
Preferred Experience/Skills:
- Strong knowledge and proficiency in SQL.
- Knowledge of the Quality-of-Care program.
- Knowledge of data integration and software enhancements/planning.
Additional Information
About Us:
At CNSI, we strive to be the market leader and most trusted partner for innovative and transformative technology-enabled solutions that improve health outcomes and reduce costs. We’re passionate about helping our clients improve the health and well-being of individuals and families. We succeed when our clients succeed.
Innovation and commitment to our mission are core to our DNA. And through our shared values, we foster an environment of inclusion, empowerment, accountability, and fun! You will be offered a competitive compensation and benefits package.
CNSI is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, marital status, genetic status, family responsibilities, protected veteran status, or any other status protected by applicable federal, state, or local law. We are proud of our diversity and encourage all qualified applicants to apply.
Kindly inquire during the interview process if this position is subject to President Biden’s Executive Order on Ensuring Adequate COVID Safety Protocols for Federal Contractors, requiring you to be vaccinated by December 8, 2021.