Job Description:

Description

Summary:

The Healthcare Federal Reporting Specialist is responsible for analyzing business problems, identify gaps, and develop 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; provide day-to-day direction on State program activities.

Working remotely within the United States is acceptable for this position.

***In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States, and to complete the required employment eligibility verification at time of hire or transfer.
CNSI will not sponsor new employment visa petitions.

Job Responsibilities:

• Provides Medicaid and 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.


• Understands the overall system architecture and cross-functional integration.


• Demonstrates in-depth knowledge of business analysis to ensure high quality.


• Communicates issues and risks to manager or direct supervisor and assists in developing solutions.

Experience/Preferred Skills Required:

• 8+ 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 Affordable care act and eligibility.


• Able to perform complex data analysis using SQL, Excel against data warehouses utilizing large datasets.


• Bachelors' Degree


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  Preferred Skills:

  
  


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  Strong knowledge and proficiency in SQL.


• Knowledge of Quality-of-Care program is highly preferred.


• Knowledge of data integration and software enhancements/planning.


• Masters' Degree

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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. LI