EDW Medicaid QA

Candidate will be required to travel to Springfield twice a year (usually June/Dec) at their own expense for meetings. Position Summary - The Medicaid Business/QA Analyst will serve as a business subject matter expert (SME) for Medicaid data and processes while performing quality assurance testing. This role bridges business knowledge of Medicaid eligibility, claims, encounters, provider enrollment, managed care, and program reporting with QA discipline, ensuring the accuracy, completeness, and usability of EDW deliverables — including data marts, inbound source data loads, outbound extracts, ILMAR reporting, and operational dashboards. Key Responsibilities 1. Business SME – Medicaid Data & Processes Act as primary business resource for interpreting Medicaid data elements, business rules, and program logic in EDW projects. Review inbound data from source systems (IES eligibility, IMPACT provider, MMIS claims, MCO encounter feeds) for accuracy and mapping alignment. Support development of data marts for program areas (eligibility, claims/utilization, provider, managed care, LTSS, behavioral health). 1. QA Planning & Execution Develop QA plans, scenarios, and test cases for EDW deliverables, focusing on business rule validation. Perform data reconciliation between inbound source files and EDW target tables/data marts. Validate transformations, aggregations, and derived fields against business requirements. Confirm ILMAR extracts meet HFS format, timeliness, and accuracy requirements. Participate in User Acceptance Testing (UAT) with program area stakeholders. 1. Data Quality & Issue Resolution Identify data anomalies, mapping issues, or business rule gaps and work with data engineers/ETL developers to resolve. Ensure referential integrity across eligibility, claims, provider, and plan data sets. Assist in defining business data quality rules for ongoing EDW monitoring. Track and document issues in defect management tools ( Azure DevOps). 1. Collaboration & Documentation Partner with HFS program staff, vendors, and technical teams to clarify requirements and validate deliverables. Review business requirements documents (BRDs), mapping specs, and data models for Medicaid accuracy. Maintain QA evidence, business rules documentation, and test results for audit/compliance purposes. Contribute to knowledge transfer and training on Medicaid EDW data usage. Required Skills & Qualifications Strong Medicaid business knowledge Understanding of HFS EDW architecture, including inbound feeds, staging, integration layers, data marts, and outbound extracts. Experience validating ILMAR and other Medicaid program reporting deliverables. Proficiency with SQL for business-level data validation and reconciliation. Experience in data warehouse QA/testing — validating data transformations, aggregations, and dimensional models. Ability to translate Medicaid policy and operational rules into testable acceptance criteria. Familiarity with HIPAA compliance and PHI handling in test environments. Strong analytical, documentation, and communication skills.