Under the direction of the Medicaid Manager, the Medicaid Analyst is responsible for analyzing, reviewing and updating complex data to ensure accurate and efficient operations of the Medicaid cost recovery program. The incumbent is responsible for providing and interpreting accurate information and guidance in support of program evaluation, strategic planning, policy development and decision-making. Success of work is measured in terms of effectiveness in accomplishing objectives. 

Reviews and analyzes Medicaid claims data to assess compliance with regulations prior to submitting claims to State;

Analyzes Medicaid claim reports to identify  and resolve errors, denials and/or held claims;

Analyzes, reviews, forecasts and trend complex claims/ encounter data;

Presents analysis and interpretation for operational review planning;

Submits student data to state to determine Medicaid eligibility and resolve errors in eligibility status;

Supports short and long term operational activities through analysis;

Develops and recommends business solutions and processes based on interpretation of data and trends through research and analysis of Medicaid claim data, including rejected claims when appropriate;

Develops business solutions based on customer request and articulate to technical developers and/or software vendors for implementation;

Implements and supports business solutions, which includes monitoring for effectiveness;

Prepares and reviews complex reporting issues;

Coordinates the Program’s self-monitoring review process and annual State audit(s);

Demonstrates a strong attention to detail and level of accuracy;

Problem solves, identifies and researches conflicting and/or inaccurate data;

Ensures interfacing with software contractor for technical support; and

Performs other duties as assigned.

Knowledge of school-based Medicaid billing software systems;

Good technical knowledge of medical billing software applications and equipment;

Good knowledge of Medicaid procedures, rules, and regulations for billing processes;

Working knowledge of productivity computer applications, such as spreadsheets, documents, database, and project management software;

Ability to establish and maintain effective working relationships with school officials and representatives from agencies outside of the school system;

Ability to exercise independent judgment;

Intermediate level of proficiency with Google Docs and automated database management systems;

Excellent communication, time/project management, problem solving, and analytical skills; and

Good oral and written communication skills.

Bachelor’s degree in related field, or equivalent experience; with five (5) or more years of direct experience in claims reporting, data analysis and data management.



Certified Professional Coder (CPC), Certified in Healthcare Compliance (CHC) or similar certification preferred.



No direct supervisory responsibilities.



The physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to stand, talk, hear, walk, sit, and use fingers, tools or controls. The employee is occasionally required to reach with hands and arms and stoop, kneel, crouch, or crawl. Specific vision abilities required by this job include close vision such as to read handwritten or typed material, the ability to adjust focus, and depth perception. While performing the duties of this job, the employee may occasionally push or lift up to 25 lbs.




The work environment characteristics are representative of those an employee encounters while performing the essential functions of the job.




None.