Senior Medicaid EDW & Federal Reporting SME (Remote)

Myticas Consulting Inc.; Illinois; Remote; USD 83,000 - 99,000; Part time

Job summary

Clover Consulting is seeking an EDW Medicaid SME (Federal Reporting & Policy) for a 12+ month contract. The role is remote with occasional travel to Illinois possible, focused on CMS-64 and related federal reporting.

You will anchor Medicaid policy knowledge and translate it into actionable business rules for data and reporting teams. The candidate will brief senior leadership, work with state programs and vendors, and ensure data quality and compliance across reporting cycles.

Qualifications

• 15+ years healthcare experience including 10+ years with State Medicaid agencies or Medicaid data programs.
• 10+ years CMS reporting experience with CMS guidance and federal requirements.
• 3+ years experience with CMS reporting such as MARS, T-MSIS, PERM, or CMS Core Set measures.
• Strong knowledge of Medicaid policy, eligibility groups, waivers, TPL, and claims adjudication.
• Able to translate policy into business rules and testable requirements.

Responsibilities

• Serve as a senior Medicaid SME for the IL EDW, guiding State and Optum teams on claims, eligibility, provider, managed care, TPL, and financial data.
• Lead CMS-64 reporting support, including expenditure categories, FMAP, reporting periods, and reconciliation to financial submissions.
• Support federal reporting work (MARS, T-MSIS, PERM, CMS Core Set) ensuring alignment with source data and guidance.
• Translate CMS guidance into clear business rules for technical teams to implement and test.
• Prepare executive briefings, issue summaries, and recommendations for senior leadership.

Skills

Medicaid policy

CMS reporting

SQL querying

Executive briefs

Data validation

Stakeholder communication

Tools

Teradata

Tableau

Power BI

Azure DevOps

JIRA

Job description

Clover Consulting is seeking an EDW Medicaid SME (Federal Reporting & Policy) for a 12+ month contract. The role is remote with occasional travel to Illinois possible, focused on CMS-64 and related federal reporting.

You will anchor Medicaid policy knowledge and translate it into actionable business rules for data and reporting teams. The candidate will brief senior leadership, work with state programs and vendors, and ensure data quality and compliance across reporting cycles.