Business Analyst – MMIS, Medicaid Pharmacy

🕒 Maio 22

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $86.800 - $124.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

🧐 Analista de Negócios

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Gainwell Technologies

SiteLinkedInTodas as Vagas

10.000+ funcionários

⚕️ Seguro de Saúde

💰 Grant em 2023-06

Healthcare Insurance • Human Services • Healthcare

A Gainwell Technologies é a principal provedora do país de soluções digitais e cloud-enabled em todo o ecossistema de serviços humanos e saúde pública. Com uma abordagem orientada por propósito, a Gainwell atende clientes nos 50 estados dos EUA, com foco em melhorar os desfechos em saúde e oferecer experiências intuitivas e centradas nas pessoas. Seu portfólio abrangente inclui modernização do Medicaid Enterprise, data analytics, serviços para prestadores e soluções para farmácia — tudo projetado para impulsionar o futuro da saúde e promover o bem-estar das comunidades.

Descrição

• The Advisor Business Analyst supports business, policy, and technical execution across one or more functional domains within MMIS Medicaid Management Information Systems (MMIS) and/or the Medicaid Pharmacy environment. • Supported domains may include Member, Provider, Claims (Medicaid, Dental and/or Pharmacy), Finance, Plan and Care Management, and Business Relationship Management. • This role supports end‑to‑end domain delivery by translating state and federal Medicaid policy and program requirements into product features, system configuration, and design artifacts. • The Business Analyst works closely with the Domain Lead, Technical Analysts, and cross‑functional teams and acts as a domain and policy subject‑matter expert (SME) to ensure successful implementation and operational readiness. • Acts as the primary Domain SME, serving as a trusted advisor to the Engagement Lead (EL) on business processes and associated regulatory and operational impacts. • Ensures compliance alignment by validating that solution design and configuration conform to CMS guidance, state policy, and documented business rules. • Supports the EL with in‑scope negotiations and change control, providing domain expertise to assess scope trade‑offs and the functional, regulatory, and operational impacts of change requests. • Lead and participate in collaborative requirements and design sessions with clients and internal teams to validate functional and technical needs. • Interpret state and federal Medicaid policy, regulations, and program rules and translate them into product features, system configuration, business rules, and design artifacts. • Serve as a policy and domain SME, supporting the Domain Lead with analysis, interpretation, and solution recommendations.

🎯 Requisitos

• Bachelor’s degree in Computer Science, Information Systems, Health Informatics, or a related field. • 5 to 8 years of hands-on experience supporting healthcare system implementations, including MMIS solutions and Medicaid Pharmacy platforms. • Experience with QNXT or similar healthcare claims/encounter management systems. • Strong knowledge of state and federal Medicaid policy, regulations, and program rules (required). • Strong understanding of Medicaid domains, including claims, member, provider, and prior authorization processes. • Demonstrated experience translating policy and program rules into system requirements, configuration support, and design artifacts. • Strong knowledge of SQL is required, particularly for data analysis and validation. • Strong client communication skills, with experience interacting directly with business stakeholders. • Proven ability to lead or support functional demonstrations, walkthroughs, and collaborative working sessions. • Strong documentation, facilitation, and analytical skills. • Experience working in SDLC and Agile delivery environments.

🏖️ Benefícios

• generous, flexible vacation policy • 401(k) employer match • comprehensive health benefits • educational assistance • a variety of leadership and technical development academies