Senior Medicaid Business Analyst – Configuration, Policy

🔥 0 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $69.4k - $99.2k / 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 Medicaid Pharmacy environments • Translate state and federal Medicaid policy and program requirements into product features, system configuration, business rules, and design artifacts • Serve as the primary domain and policy subject-matter expert and trusted advisor to the Engagement Lead • Validate solution design and configuration against CMS guidance, state policy, and documented business rules • Support scope negotiations and change control by assessing functional, regulatory, and operational impacts • 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 • Document and communicate domain-level decisions, risks, assumptions, dependencies, and downstream impacts • Support domain-specific configuration and implementation activities within Design, Development, and Implementation projects • Partner with technical teams to align configurations with approved designs, policy interpretations, and business rules • Review test cases and provide subject-matter support during System Integration Testing and User Acceptance Testing • Support defect analysis, root-cause investigation, resolution, retesting, and functional readiness validation • Support operational readiness, environment/data/process/staffing readiness, operational readiness reviews, parallel testing, performance testing, cutover, transition to operations, and hypercare • Lead and support client communication, functional demos, solution walkthroughs, and collaborative working sessions • Support documentation, knowledge transfer, and ongoing operational support

🎯 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 provider/claims 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 • 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 • Knowledge of MITA (Medicaid Information Technology Architecture) preferred • Experience with system integrations, EDI/X12 transactions, analytics, and reporting preferred • Familiarity with state and federal healthcare regulations and compliance standards preferred

🏖️ Benefits

• Fully remote options from most US locations and territories • Flexible work flexibility • Learning and career development • Generous, flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies • Equal opportunity employment