Medicaid Program Integrity SME — Part-Time, Remote

Estrada Consulting, Inc.; Maryland; Remote; USD 83,000 - 110,000; Part time

Job summary

Estrada Consulting, Inc. is seeking a Medicaid program integrity subject matter expert for a part-time advisory role on a state data analytics engagement.

You will help the analytics team interpret claims and program data, define the rules behind analyses, and review significant findings with State staff before any action is taken. The project involves a cloud-based data analytics capability for a state Medicaid-funded developmental disabilities program.

Qualifications

• 1–2 years or more working in healthcare, Medicaid or other health and human services programs
• Knowledge of program operations, claims and utilization data, provider services, financial oversight or program integrity
• Able to explain program rules and data in plain language to analysts and State reviewers
• US based and able to pass a background check before access to protected health data

Responsibilities

• Interpret program rules, waiver requirements, claims and utilization data for the analytics team.
• Help define, validate and document rules-based checks and indicators.
• Review significant analytical findings with State subject matter experts before recommended actions are taken.
• Identify patterns, risks and opportunities for program and operational improvement.
• Join periodic workstream reviews and contribute to documentation and knowledge transfer.

Skills

Interpret program rules

Explain data to analysts

Communicate with State reviewers

Identify patterns and risks

Data interpretation

Education

Bachelor's degree in public health, healthcare administration, health informatics, public administration or related field

Job description

Estrada Consulting, Inc. is seeking a Medicaid program integrity subject matter expert for a part-time advisory role on a state data analytics engagement.

You will help the analytics team interpret claims and program data, define the rules behind analyses, and review significant findings with State staff before any action is taken. The project involves a cloud-based data analytics capability for a state Medicaid-funded developmental disabilities program.