Senior Business Analyst – Provider

🕒 July 2

🤠 Texas, Virginia – Remote

🤠 Texas – Remote ⚔️ Virginia – Remote

💵 $69.4k - $99.2k / year

⏰ Full Time

🟠 Senior

🧐 Business Analyst

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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

• Serve as the primary Domain SME and trusted advisor on business processes, including regulatory and operational impacts • Ensure solutions align with CMS guidance, state policy, and documented business rules • Support scope negotiations and change control by assessing trade-offs and evaluating impacts of requested changes • Lead and participate in requirements and design sessions to validate functional and technical needs • Interpret federal and state Medicaid policies translating them into configuration, features, and design artifacts • Develop and maintain domain design documentation, including comprehensive Design Document covering workflows, interfaces, transactions, letters, and reports • Support configuration and implementation across Design, Development, and Implementation (DDI) • Partner with technical teams to ensure solutions align with approved designs and policies • Provide SME support during testing phases and assist with defect analysis and resolution validation • Support operational readiness across environments, processes, and staffing • Deliver functional demos and solution walkthroughs to validate product alignment with client needs • Facilitate working sessions across teams for requirements discussions 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 • educational assistance • comprehensive health benefits • 401(k) employer match • leadership and technical development academies