Business Analyst, Reference Data

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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

• Analyze, design, and document business requirements related to healthcare claims, reference data, and code sets • Work with stakeholders to gather and define requirements involving ICD, CPT, HCPCS, UB‑04, revenue codes, provider taxonomy, and other healthcare reference data • Develop and maintain business analysis artifacts such as BRDs, functional specifications, process flows, decision tables, and traceability matrices • Translate business, policy, and coding requirements into clear functional objectives for technical teams • Perform impact analysis for code‑set changes, regulatory updates, and policy changes across claims processing systems • Support testing activities, including defining test scenarios and validating system outputs • Participate in technical reviews and project discussions to ensure requirement alignment across lifecycle phases • Identify opportunities for business process improvement and data governance enhancements • Collaborate with developers, testers, and stakeholders for issue resolution, defect triage, and root‑cause analysis • Communicate effectively with business and technical teams through documentation, meetings, and presentations

🎯 Requirements

• 10+ years of experience in a Business Analyst role • Strong experience in healthcare domain (Medicaid / Medicare / claims processing) • Working knowledge of healthcare code sets, including: ICD‑10‑CM / ICD‑10‑PCS CPT, HCPCS UB‑04 institutional billing elements Revenue codes, modifiers, type of bill, place of service • Experience in requirements gathering, analysis, and documentation • Strong understanding of claims lifecycle, adjudication, and reference data workflows • Experience working with SDLC processes, testing, and system configuration concepts • Strong analytical and problem‑solving skills • Proficiency in Microsoft Excel and data analysis tools • Experience with SQL for data analysis and validation • Strong communication and stakeholder management skills.

🏖️ Benefits

• Remote Opportunity