Medicaid Reporting Subject Matter Expert

CSpring; United States; Remote; USD 140,000 - 200,000; Full time

Job summary

CSpring seeks a Senior Medicaid reporting SME to guide state and Optum teams on claims, eligibility, and financial data aligned with CMS rules.

You will lead CMS-64 reporting, provide executive briefings, and translate policy into actionable business requirements for technical teams. Strong SQL and data warehouse knowledge are essential.

Qualifications

• 15+ years of healthcare experience with Medicaid context.
• 10+ years with State Medicaid agencies or MMIS/MES vendors.
• 3+ years in CMS reporting (MARS, T-MSIS, PERM, Core Set).
• Ability to translate policy into business rules for technical teams.
• Travel to Springfield, IL a few times per year.

Responsibilities

• Serve as senior Medicaid SME for IL EDW and CMS-64 reporting.
• Lead CMS-64 and related federal reporting efforts end-to-end.
• Translate CMS guidance into clear business requirements.
• Deliver executive briefings and leadership recommendations.
• Mentor analysts and build knowledge backups.

Skills

SQL

Medicaid data

CMS reporting

Executive briefing

Stakeholder mgmt

Tools

Teradata

Business Objects

Tableau

Power BI

Azure DevOps

JIRA

SharePoint

Job description

All Jobs > Medicaid Reporting Subject Matter Expert

Medicaid Reporting Subject Matter Expert
Fully Remote

Description

At CSpring, we believe in the power of data to drive decisions and real-world impact. We’re a purpose-driven consulting firm specializing in data strategy, data engineering, and data analytics. Our clients span the public and private sectors, and our work helps them solve complex problems, gain insights, and achieve measurable results.

We're seeking talented professionals who are collaborative, curious, and committed to making a difference that thrive at the intersection of data, technology, and business strategy. Whether you're passionate about transforming public programs, enabling executive decision-making, or modernizing legacy systems, you'll find meaningful work and purpose here.

Why You’ll Love Working Here

• Purposeful Projects – Improve systems that serve real people by delivering smarter data, streamlined processes, and strategic insight.
• People-First Culture – We’re as committed to your growth as we are to delivering high-impact solutions. You’ll find support, autonomy, and community here.
• Strategic, Hands-On Work – From data architecture and documentation to client workshops and solution delivery, you’ll influence every step of the process.
• Collaborative Trust – Our clients rely on us to listen carefully, deliver consistently, and guide wisely. We partner with integrity, curiosity, and heart.

What You’ll Do

As the senior business and policy anchor for Medicaid data and federal reporting, you will:

• Serve as a senior Medicaid business and policy SME for the IL EDW, guiding State and Optum teams on claims, eligibility, provider, managed care/encounter, TPL, and financial data and how they relate to Medicaid program rules.
• Lead the business side of CMS-64 reporting support, including understanding expenditure categories, FMAP and enhanced match rules, reporting periods, prior period adjustments, and reconciliation of EDW data to State financial submissions.
• Support other federal reporting work such as MARS, T-MSIS, PERM, and CMS Core Set/Quality of Care measures, making sure reports tie back to source data and federal guidance.
• Interpret federal and State policy (CMS guidance, SMD/SHO letters, the State Medicaid Manual, the State Plan and waivers, and State administrative rules) and translate it into clear business rules, requirements, and acceptance criteria.
• Explain the “why” behind the numbers. Help State users and leadership understand trends, variances, and data issues in plain business terms, along with the policy or operational drivers behind them.
• Prepare and deliver executive briefings, issue summaries, and recommendations to Optum leadership and State senior leadership, including Bureau Chiefs, Deputy Administrators, and the Agency Director.
• Work with State finance and program teams (including the Bureau of Fiscal Operations), MCO partners, and other vendors on joint reporting timelines, dependencies, and approvals.
• Review and validate report logic, data mappings, and test results from a business and policy standpoint before deliverables go to the State or CMS.
• Identify data quality and reporting risks early, and recommend practical options to resolve them.
• Mentor analysts, developers, and data specialists on Medicaid business knowledge, and help build documented knowledge and backup coverage so no single person is a point of failure.
• Stay current on federal and State Medicaid changes (CMS rules, legislative mandates, federal reporting system changes) and advise the team and the State on impacts to the EDW and reporting.

Requirements

• 15+ years of healthcare experience, including 10+ years working directly with or for State Medicaid agencies, MMIS/MES vendors, or Medicaid data warehouse/decision support programs.
• Hands-on experience supporting CMS-64 reporting, including expenditure reporting, FMAP/enhanced match, claiming categories, and reconciliation of data to financial reports.
• 3+ years of experience with other federal CMS reporting such as MARS, T-MSIS, PERM, or CMS Core Set measures.
• Strong working knowledge of Medicaid and CHIP policy and program rules, including eligibility groups, benefits and covered services, managed care, waivers, TPL, and claims adjudication.
• Deep understanding of Medicaid data (claims, encounters, eligibility, provider, financial) and how it flows from source systems into a data warehouse and federal reports.
• Proven ability to present to and advise senior executives, including State agency directors or equivalent, with clear and concise briefings.
• Ability to translate policy and federal guidance into business rules and requirements that technical teams can build and test.
• Working ability to query and validate data using SQL or similar tools against large datasets.
• Excellent written and verbal communication, sound judgment, and the ability to stay calm and credible in high-visibility, deadline-driven situations.
• Ability to travel to Springfield, IL three (3) to four (4) times per year or as needed.

Bonus Experience

• Experience with State Medicaid finance operations, CMS-64 quarterly cycles, CMS-37 budget reporting, or federal draw and claiming processes.
• Familiarity with CMS federal financial reporting systems (MBES/CBES) and the transition to MACFin.
• Experience supporting MMIS/MES CMS certification, audits, or federal reviews.
• Product owner or lead SME experience for a federal reporting module or Medicaid DSS/data warehouse.
• Prior experience with Illinois Medicaid programs, or Medicaid managed care.
• Experience with Teradata, Business Objects, Tableau, Power BI, or similar reporting and data tools.
• Experience using Azure DevOps, JIRA, or similar tools, and SharePoint for documentation and collaboration.
• Located within driving distance of Springfield, IL.

Come Build With Us

At CSpring, we unlock the potential of people and data. If you're ready to lead meaningful projects, collaborate with passionate teams, and grow your career in a people‑first consulting environment—