SQL/ Medicaid Functional Consultant

About the role

We are seeking a SQL / Medicaid Functional Consultant to support our NYS client. This role supports the Enrollment track of a New York State Medicaid LTSS modernization program, with a focus on requirements, functional solution design, and HIPAA 834 and 278 transaction interchanges.

Responsibilities

• Gather, analyze, and document business and functional requirements for the Enrollment track of the Medicaid LTSS modernization program.
• Develop and maintain BRDs, FRDs, process flows, data mappings, and interface specifications that clearly articulate functional solution requirements.
• Support HIPAA 834 and 278 transaction interchanges, including analysis of segments, loops, code sets, companion guides, and eMedNY inbound/outbound transactions.
• Use SQL and basic data analysis to support enrollment reconciliation, transaction validation, defect investigation, and issue resolution.
• Partner with State, MCO, vendor, development, and QA stakeholders on requirements clarification, testing support, and defect triage.

Qualifications

• Mandatory Qualifications:
• 4+ years of experience as a Business / Functional Consultant in healthcare and/or public sector programs.
• 2+ years of SQL experience.
• 2+ years of Medicaid experience.
• 1+ years of recent Medicaid and LTSS knowledge, including enrollment and managed care.
• Hands-on experience with HIPAA 834 or 278 transactions, including segments, loops, code sets, and companion guides.
• Experience with NY eMedNY and related inbound/outbound transaction interchange.
• Ability to produce BRDs, FRDs, process flows, data mappings, and interface specifications.
• Strong client-facing communication skills with the ability to work with State, MCO, and vendor stakeholders.
• Experience partnering with development and QA teams on requirements clarification, testing, and defect triage.
• Proficiency with JIRA, Confluence, Visio, and MS Office.
• Desirable Qualifications:
• Experience supporting both HIPAA 834 and 278 transactions.
• 3+ years supporting Enrollment on a Medicaid platform.
• Work experience with eMedNY.
• Familiarity with Managed Long Term Care enrollment concepts and non-MAGI workflows.
• SQL/basic data analysis for reconciliation and defect investigation.