Experienced Business Analyst – MMIS, Medicaid Pharmacy

🕒 June 20

🏛️ District of Columbia – Remote

🏛️ District of Columbia – 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

• Supports business, policy, and technical execution across MMIS Medicaid Management Information Systems and/or the Medicaid Pharmacy environment • Acts as the primary Domain SME, serving as a trusted advisor 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 • Leads and participates in collaborative requirements and design sessions with clients and internal teams to validate functional and technical needs • Interprets state and federal Medicaid policy, regulations, and program rules and translates them into product features, system configuration, business rules, and design artifacts • Develops and maintains domain design documentation, ensuring accuracy, completeness, and traceability of requirements and acceptance criteria • Supports operational readiness activities and client engagements, including requirement discussions, design reviews, and issue resolution

🎯 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 • leadership and technical development academies