Note: The job is a remote job and is open to candidates in USA. Gainwell Technologies is a company focused on improving healthcare through technology, and they are seeking an Experienced Data Analyst for their Medicaid Quality program. This role involves designing and validating healthcare quality measures, ensuring data quality, and communicating complex methodologies to various stakeholders.
Responsibilities
- Demonstrated experience interpreting and implementing HEDIS or HEDIS-like specifications within Medicaid and managed care environments, including measurement periods, continuous enrollment, exclusions, and annual specification updates
- Strong understanding of Medicaid eligibility, enrollment, and managed care models (MCO), along with deep familiarity with claims, encounters, pharmacy, provider, and member data used for quality reporting
- Advanced working knowledge of ICD‑10‑CM, CPT/HCPCS, and NDC codes and the application of standardized value sets in HEDIS measure logic
- Proven experience validating quality measure results, performing data quality assessments, reconciling outputs, and supporting internal quality reviews, state reporting, and audit inquiries
- Ability to clearly explain complex quality metric logic, assumptions, limitations, and results to Medicaid clients, clinicians, business stakeholders, and leadership
- Expert‑level SQL skills, including complex joins, performance optimization, applied to large‑scale Medicaid claims and eligibility datasets
- Experience working with normalized and analytical data models for Medicaid claims, encounters, pharmacy, eligibility, provider, and member data to support scalable quality measure computation
- Strong ability to design and execute data transformations that convert raw Medicaid source data into analytics‑ready datasets for pay-for-performance and quality reporting
- Proficiency using Python or similar tools to support exploratory analysis, measure validation, reconciliation, and automation of quality analytics workflows
- Experience maintaining reusable, version‑controlled incentive measure logic and documenting methodologies to support annual specification changes and knowledge transfer
Skills
- Bachelor's or Master's degree in Computer Science, Healthcare Informatics, Biostatistics, MIS, Statistics, or related fields
- 10+ years in healthcare reporting, BI, analytics, data warehousing, and medical billing, with SME‑level knowledge of Medicaid/Medicare, payers, providers, or health services
- Strong SQL, Oracle, ETL, DW infrastructure, data extraction/transformation, and experience with reporting tools such as Business Objects
- Proficient in SDLC methodologies and translating business needs into enterprise BI, reporting, and analytical requirements
- Excellent written/verbal communication with strong analytical and problem‑solving abilities for stakeholder engagement
- Demonstrated experience interpreting and implementing HEDIS or HEDIS-like specifications within Medicaid and managed care environments, including measurement periods, continuous enrollment, exclusions, and annual specification updates
- Strong understanding of Medicaid eligibility, enrollment, and managed care models (MCO), along with deep familiarity with claims, encounters, pharmacy, provider, and member data used for quality reporting
- Advanced working knowledge of ICD‑10‑CM, CPT/HCPCS, and NDC codes and the application of standardized value sets in HEDIS measure logic
- Proven experience validating quality measure results, performing data quality assessments, reconciling outputs, and supporting internal quality reviews, state reporting, and audit inquiries
- Ability to clearly explain complex quality metric logic, assumptions, limitations, and results to Medicaid clients, clinicians, business stakeholders, and leadership
- Expert‑level SQL skills, including complex joins, performance optimization, applied to large‑scale Medicaid claims and eligibility datasets
- Experience working with normalized and analytical data models for Medicaid claims, encounters, pharmacy, eligibility, provider, and member data to support scalable quality measure computation
- Strong ability to design and execute data transformations that convert raw Medicaid source data into analytics‑ready datasets for pay-for-performance and quality reporting
- Proficiency using Python or similar tools to support exploratory analysis, measure validation, reconciliation, and automation of quality analytics workflows
- Experience maintaining reusable, version‑controlled incentive measure logic and documenting methodologies to support annual specification changes and knowledge transfer
Benefits
- Generous, flexible vacation policy
- Educational assistance
- Comprehensive health benefits
- 401(k) employer match
- Variety of leadership and technical development academies to help build your skills and capabilities
Company Overview