Medicaid Data Specialist (Federal Reporting)

Description At CSpring, we believe in the power of people and data to drive real-world impact. We’re a purpose-driven consulting firm that helps organizations solve complex problems, gain insights, and achieve measurable results. Our clients span the public and private sectors, and our work — from data strategy and engineering to workforce transformation — improves lives across Indiana and beyond. We’re seeking talented professionals who are collaborative, curious, and committed to making a difference. Why You’ll Love Working Here

• Work that matters at scale. The decisions you make here affect how Illinois manages its Medicaid program — data quality, compliance, and reporting accuracy have direct downstream impact on the people the state serves.
• A team that trusts your expertise. At CSpring, SMEs aren't just consulted — they're the ones who move things forward. You'll provide real direction to both technical and business teams, not just recommendations that get ignored.
• Deep, interesting problems. Claims adjudication, recipient eligibility, provider enrollment, federal extract integrity — this work is substantive, and you'll be solving problems that don't have easy answers.
• A culture that's warm and grounded. CSpring is a firm where people know each other and look out for each other. Collaboration isn't a value on a poster — it's how the work actually gets done.

What You’ll Do As the EDW Medicaid SME, you'll be the authoritative voice on Medicaid data and federal reporting for a major state implementation — guiding decisions, validating solutions, and keeping the work grounded in what Medicaid programs actually need.

• Provide direction, guidance, and recommendations supporting decision-making for a large Medicaid data warehouse implementation and ongoing operations.
• Lead and guide internal and external stakeholders through complex determinations involving claims processing and adjudication, recipient and provider eligibility, and third-party liability.
• Proactively identify state Medicaid agency data needs and recommend solutions backed by credible justification and validated proof of concepts.
• Direct technical and business teams on healthcare data topics, ensuring Medicaid data is understood and used appropriately across the project.
• Serve as the subject matter expert for CMS and state federal reporting requirements, including T-MSIS, PERM, MARS, and other CMS-mandated submissions — ensuring data accuracy, compliance, and audit readiness.
• Analyze large Medicaid data sets (claims, eligibility, provider, and federal extracts) using advanced SQL within an EDW environment.
• Partner with stakeholders to understand data requirements and support development of interfaces, dashboards, data visualizations, and decision aids.
• Produce and manage the delivery of activity reports, value analytics, and critical deliverables to external stakeholders and clients.
• Proactively recommend enhancements and process improvements driven by Medicaid best practices, standards, and policies.
• Travel to Springfield, IL approximately three to four times per year for onsite client meetings.

Requirements:

• 10+ years of experience in information technology, with at least 5 years working directly with or for state Medicaid agencies, supporting business initiatives through data analysis, business requirements writing, and system testing and validation.
• 5+ years as a subject matter expert for CMS and state Medicaid federal reporting — including T-MSIS, PERM, MARS, and other mandated submissions — with demonstrated focus on data accuracy, compliance, and audit readiness.
• Solid understanding of claims processing and adjudication, recipient/eligibility data, and provider/enrollment data processes.
• Advanced SQL proficiency, with 5+ years analyzing large Medicaid data sets (claims, eligibility, provider, federal extracts) in an Enterprise Data Warehouse environment.
• Working knowledge of CMS reporting requirements and the programs they cover.
• Strong verbal and written communication skills, with the ability to present to and collaborate with managers, executives, and director-level clients.
• Ability to travel to Springfield, IL three to four times per year.

Preferred Qualifications

• 2+ years of experience with HEDIS, CHIPRA, or similar quality metrics.
• Experience with Teradata or an equivalent enterprise database management system.
• Familiarity with JIRA, Rally, Azure DevOps, or equivalent project tracking tools.
• Prior experience on a large-scale Medicaid system implementation project.
• Located within a 3–5 hour drive of Springfield, IL.

At CSpring, we