Business Analyst – MMIS, Medicaid Pharmacy

🕒 May 22

🇺🇸 United States – Remote

💵 $86.8k - $124k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Business Analyst

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Healthcare Insurance • Human Services • Healthcare

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• 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.

🎯 Requirements

• 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.

🏖️ Benefits

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