Sr Medicaid Subject Matter Expert - CMS-64 - Federal Reporting and Policy - Remote
UnitedHealth Group · Posted Nov 7, 2026
- Remote, United States
- Remote
- Full-time · Senior
This senior Medicaid SME supports the State Medicaid Agency Enterprise Data Warehouse (EDW). The role is the business and policy anchor for Medicaid data and federal reporting, with a primary focus on CMS-64 and related financial and federal reporting.
Responsibilities
- Serve as a senior Medicaid business and policy SME for the IL EDW, guiding State and Optum teams on claims, eligibility, provider, managed care/encounter, TPL, and financial data and how they relate to Medicaid program rules
- Lead the business side of CMS-64 reporting support, including understanding expenditure categories, FMAP and enhanced match rules, reporting periods, prior period adjustments, and reconciliation of EDW data to State financial submissions
- Support other federal reporting work such as MARS, T-MSIS, PERM, and CMS Core Set/Quality of Care measures, making sure reports tie back to source data and federal guidance
- Interpret federal and State policy (CMS guidance, SMD/SHO letters, the State Medicaid Manual, the State Plan and waivers, and State administrative rules) and translate it into clear business rules, requirements, and acceptance criteria
- Explain the 'why' behind the numbers Help State users and leadership understand trends, variances, and data issues in plain business terms, with the policy or operational drivers behind them