Senior Business Analyst – MMIS Claims Processing

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🔥 1 hour ago

🏰 Missouri – Remote

🏰 Missouri – Remote

⏰ Full Time

🟠 Senior

🧐 Business Analyst

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S2Tech

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 1997

🤝 B2B

🏛️ Government

⚕️ Healthcare Insurance

B2B • Government • Healthcare Insurance

S2Tech is a U. S. -based IT and business services firm (doing business as Seven Seas Technologies, Inc. ) that delivers advisory, integration, technical, and quality services to enterprise and government clients. The company emphasizes collaborative partnerships and open communication to design and operate solutions—notably long-standing support for Medicaid MMIS and other healthcare clients—using onshore and offshore resources to improve processes, reduce costs, and provide 24/7 production support. S2Tech also engages in community impact through its Fortune Fund nonprofit initiatives.

📋 Description

• Lead requirements gathering, analysis, documentation, and validation activities for MMIS modernization initiatives with a primary focus on Claims Processing • Facilitate Joint Application Design (JAD) sessions and working sessions with state stakeholders, business teams, technical teams, and vendors • Translate complex business needs into clear, structured, and testable business requirements using established business analysis methodologies • Track requirements from initial scope definition through refinement, validation, implementation, and testing support • Conduct current-state versus future-state gap analysis and recommend modernization approaches aligned with Commonwealth objectives • Ensure requirements traceability throughout the Software Development Life Cycle (SDLC) • Support defect triage, operational impact analysis, issue resolution, and change management activities • Partner closely with development and QA teams to ensure business intent is accurately implemented • Lead analysis activities supporting modernization of the MMIS Claims Processing solution, including: • - Claims intake and submission workflows • - Claims editing and validation • - Claims adjudication and pricing • - Payment processing and financial disposition • - Denials, suspensions, adjustments, and voids • - Coordination of Benefits (COB) • - Third Party Liability (TPL) • - Managed Care encounter processing • - Provider reimbursement methodologies • - Claims lifecycle reporting and operational monitoring • Analyze and document business requirements supporting multiple claim submission channels, including: • - Provider Web Portal • - Electronic Data Interchange (EDI) • - X12 transaction processing • - Batch file interfaces • - Clearinghouse integrations • - System-to-system interfaces • Develop business requirements supporting the processing of standard healthcare transactions, including: • - 837 Institutional (837I) • - 837 Professional (837P) • - 837 Dental (837D) • - 835 Electronic Remittance Advice • - 270/271 Eligibility Inquiry & Response • - 276/277 Claim Status Inquiry & Response • - Other HIPAA-compliant X12 transactions supporting Medicaid operations • Collaborate with business and technical teams to analyze: • - Claims editing rules • - Benefit and policy validation • - Payment logic • - Pricing methodologies • - Provider reimbursement • - Financial reconciliation • - Exception handling • - Operational workflows • Produce comprehensive Business Requirements Documents (BRDs) including: • - Business background and objectives • - Current-state and future-state business processes • - Claims workflow analysis • - Business rules • - Detailed business requirements • - Operational impacts and dependencies • - Assumptions • - Key decisions • - Open issues • - Testing considerations • - Validation scenarios • Develop: • - Process flows • - Decision trees • - Use cases • - Decision tables • - Data mapping documentation • - Interface specifications • - Business rules catalogs • - Workflow diagrams • Maintain high-quality documentation standards across all deliverables • Leverage AI tools and prompt engineering techniques to support requirements generation, business analysis activities, and documentation development • Create and refine AI prompts to improve the quality and efficiency of requirements-related deliverables • Evaluate AI-generated output for accuracy, completeness, consistency, and business relevance • Apply critical thinking and business judgment when utilizing AI-assisted analysis techniques • Build strong working relationships with client stakeholders, project leadership, and cross-functional teams • Facilitate productive discussions and diplomatically challenge unclear or incomplete requirements when necessary • Communicate complex business and technical concepts effectively to both technical and non-technical audiences • Anticipate downstream impacts, risks, dependencies, financial implications, and operational considerations associated with requirements decisions • Operate independently as a self-starter while contributing to broader modernization program objectives

🎯 Requirements

• Strong experience as a Business Analyst supporting MMIS/MES or Medicaid modernization initiatives • Direct experience supporting MMIS Claims Processing • Strong understanding of the complete Medicaid claims lifecycle from submission through adjudication, payment, adjustment, and financial reconciliation • Experience with claims editing, pricing, adjudication logic, payment methodologies, and business rules • Experience working with HIPAA X12 healthcare transaction standards • Experience supporting electronic claims processing and multiple claim intake channels • Strong preference for candidates with CLIENT-SIDE MMIS experience (state agency/business operations perspective) versus solely vendor-module implementation experience • Demonstrated experience facilitating stakeholder sessions, JAD workshops, and executive-level business discussions • Proven experience producing high-quality BUSINESS requirements (not solely functional or technical requirements) • Deep understanding of: • - Requirements gathering and validation • - Business process analysis • - SDLC methodologies • - Gap analysis • - Medicaid claims operations • - Claims adjudication business rules • - Healthcare payment processing • - Medicaid policy-driven systems • Strong verbal and written communication skills with close attention to detail • Ability to manage ambiguity and operate effectively within large-scale enterprise modernization efforts

🏖️ Benefits

• Medical / Dental / Vision Insurance – insurance premium assistance provided • Additional Insurance (Life, Disability, etc.) • Paid Time Off • 401(k) Retirement Savings Plan & Health Savings Account • Various training courses to promote continuous learning • Corporate Wellness Program