Senior Technical Business Analyst – CEF Configuration

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🔥 7 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – 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

• Design, develop, test, document, and maintain advanced SQL queries, reusable scripts, custom stored procedures, functions, and database utilities • Create developer-ready technical specifications for custom stored procedures, including source and target tables, joins, parameters, processing logic, exception handling, dependencies, security, performance, testing, and deployment or rollback considerations • Translate approved technical specifications into production-ready or deployment-ready SQL code • Develop reusable SQL toolkits for approved field updates, supporting data retrieval, query input combination, and test-case reproduction or debugging • Optimize SQL solutions for accuracy, maintainability, performance, scalability, and safe execution across Medicaid claims and healthcare datasets • Partner with business analysts, Advisors, database administrators, application developers, testing teams, and release teams from requirements through post-production validation • Build controlled update scripts for repeatable data corrections using pre-update checks, transaction handling, row-count verification, exception reporting, and post-update reconciliation • Develop automated audit and comparison processes to identify and classify incorrect, invalid, incomplete, or missing database information • Produce Excel-ready datasets and exception reports for remediation, technical review, and audit response • Conduct post-implementation monitoring and reconciliation • Analyze and support QNXT claims-processing and healthcare data solutions across contracts, benefits, fee schedules, payment methodologies, capitation, business rules, adjudication logic, edits, X12 transactions, and CARC/RARC processing • Perform claim-level and population-level root cause analysis for denials, pends, unexpected edits, underpayments, overpayments, duplicate conditions, encounter rejections, and data-quality issues • Determine whether issues originate from configuration, database data, stored procedure logic, policy interpretation, user processing, interfaces, product functionality, or dependencies • Quantify affected claims and populations, compare expected and actual results, document evidence, and recommend corrective solutions • Support production incidents, client inquiries, audit requests, configuration defects, approved data fixes, custom reporting, and priority troubleshooting • Produce technical documentation, data mappings, process flows, test cases, implementation plans, validation evidence, runbooks, and support procedures • Participate in requirements sessions, technical design and code reviews, defect triage, solution walkthroughs, release-readiness reviews, and knowledge-transfer activities • Follow separation-of-duties, peer-review, change-control, security, and production-access requirements • Manage assigned technical work from intake through requirements clarification, design, development, testing, implementation, validation, documentation, and closure

🎯 Requirements

• Advanced SQL development expertise, including complex joins, subqueries, common table expressions, window functions, temporary tables, dynamic SQL, transactions, error handling, performance tuning, and custom stored procedure development • Demonstrated technical writing experience creating detailed, developer-ready specifications for stored procedures, database solutions, data corrections, interfaces, or similar technical components • Five or more years of combined education and relevant work experience in technical business analysis, SQL or database development, healthcare data analysis, systems analysis, claims processing, or a related technical discipline • Thorough understanding of relational database concepts, normalized data models, schemas, tables, views, keys, indexing, referential integrity, and parent-child data relationships • Ability to create safe update scripts using transactions, validation checks, affected-row controls, rollback logic, audit logging, and reconciliation queries • Experience building automated audit or data-quality processes for large record populations • Strong knowledge of Medicaid claims processing, claims adjudication, provider reimbursement, benefits, pricing, edits, encounters, and financial processing • Experience analyzing X12 healthcare transactions, including 837 and 835 data and associated claim adjustment reason and remittance advice remark codes • Experience with SQL Server Management Studio, source control such as Git or Azure DevOps, work-tracking tools such as Jira or ServiceNow, and structured release-management practices • Relevant postsecondary education in Computer Science, Information Systems, Data Analytics, Health Informatics, Business Administration, or a related discipline may count toward the combined education and experience requirement • Strong analytical, problem-solving, communication, facilitation, and stakeholder-management skills • Video cameras must be used during interviews and the initial week of orientation • Photo will be taken during screening for verification in all steps of the recruitment process • Stable internet connection and quiet location for screenings, interviews, and meetings

🏖️ Benefits

• Work flexibility • Learning and career development • Technical credentials and certifications • Generous, flexible vacation policy • Educational assistance • Leadership and technical development academies • 401(k) employer match • Comprehensive health benefits • Flexible remote work options

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