Senior Business Analyst – Provider

🔥 0 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $69.4k - $124k / year

⏰ Full Time

🟠 Senior

🧐 Business Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

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

• Support business, policy, and technical execution across functional domains within MMIS and/or the Medicaid Pharmacy environment • Translate state and federal Medicaid policy and program requirements into product features, system configuration, business rules, and design artifacts • Act as the primary domain subject matter expert and trusted advisor to the Engagement Lead • Ensure solution design and configuration align with CMS guidance, state policy, and documented business rules • Evaluate scope trade-offs and functional, regulatory, and operational impacts for negotiations and change control • Lead and participate in requirements and design sessions with clients and internal teams • Develop and maintain domain design documentation covering workflows, interfaces, X12 EDI transactions, letters, and reports • Ensure requirements and acceptance criteria are accurate, complete, and traceable • Document and communicate decisions, risks, assumptions, dependencies, and downstream impacts • Support configuration and implementation activities across Design, Development, and Implementation • Configure claims, plan, provider, member, and pharmacy functional areas • Review test cases and provide SME support during SIT and UAT • Assist with defect analysis, root-cause investigation, resolution, retesting, and functional-readiness validation • Support operational readiness, parallel testing, performance testing, cutover planning, transition to operations, and hypercare • Partner with domain leads, technical teams, and stakeholders • Lead and support client interactions, requirements discussions, design reviews, issue resolution, demos, walkthroughs, working sessions, knowledge transfer, and ongoing operations

🎯 Requirements

• 5 to 8 years of hands-on experience supporting healthcare system implementations, including MMIS solutions and Medicaid Pharmacy platforms • 9+ years of hands-on experience supporting healthcare system implementations, including MMIS solutions and Medicaid Pharmacy platforms • Bachelor’s degree in Computer Science, Information Systems, Health Informatics, or a related field • Experience with QNXT or similar healthcare claims/encounter management systems • Strong knowledge of state and federal Medicaid policy, regulations, and program rules • Strong understanding of Medicaid domains, including claims, member, provider, and prior authorization processes • Experience translating policy and program rules into system requirements, configuration support, and design artifacts • Strong knowledge of SQL, particularly for data analysis and validation • Strong client communication skills and experience interacting directly with business stakeholders • Experience leading or supporting functional demonstrations, walkthroughs, and collaborative working sessions • Strong documentation, facilitation, and analytical skills • Experience working in SDLC and Agile delivery environments • Knowledge of MITA is an advantage • Experience with system integrations, EDI/X12 transactions, analytics, and reporting is an advantage • Familiarity with state and federal healthcare regulations and compliance standards is an advantage

🏖️ Benefits

• Work flexibility • Learning and career development • Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies