Business Analyst – CMdS Claims, Member & Finance Implementation

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OmegaHires

WebsiteLinkedInAll Job Openings

11 - 50 employees

🎯 Recruiter

🏢 Enterprise

Recruitment • Enterprise • IT Services

OmegaHires is a full-service digital and enterprise IT staffing firm that focuses on providing both permanent and contingent workforce solutions across various digital and enterprise technologies. The company specializes in UX development with full stack developers using modern technologies such as React, Angular, and Node. js, as well as microservices development utilizing Java, Scala, Go, and SQL. OmegaHires also provides expertise in integration and big data technologies, DevOps for automated CI/CD pipelines, and enterprise IT management including ERP and SAP systems. Committed to "responsible recruiting," OmegaHires uses unique sourcing and assessment methodologies and offers training and mentorship to ensure candidates meet the evolving needs of their clients.

📋 Description

• Own requirements and functional design for assigned CMdS Claims, Member, Finance, and related interface modules • Define epics, user stories, definition of done, and priorities aligned with Medicaid policy, MES certification goals, and release plans • Facilitate working sessions and clarify requirements for development and QA • Resolve functional questions during build and test • Track scope, dependencies, risks, decisions, and traceability from legacy rules through CMdS design to test evidence • Lead functional design for claims intake, claim types, edits, adjustments, voids, crossovers, encounters, remittance, and edit disposition • Lead design for eligibility spans, aid categories, benefit packages, enrollment, MCO/FFS indicators, and eligibility-system interfaces • Lead design for payment cycles, budget accounts, categories of service, fund splits, administrative payment paths, financial transactions, and reporting/accounting controls • Produce BRDs, FRDs, process flows, data mappings, gap analyses, and configuration workbooks for build and UAT • Conduct design walkthroughs, address edge cases, and support defect triage with developers • Partner with QA on test scenarios, expected results, and regression packs • Support SIT, UAT, and parallel/run-compare activities against legacy MMIS outcomes • Validate Medicaid policy and MES operational readiness, including security, audit, reporting, and interfaces • Run workshops with business owners, SMEs, fiscal, and operations stakeholders • Align designs to CMS MES expectations for modularity, interoperability, standards-based interfaces, and certification evidence • Support change management through training outlines, release notes, and operational runbooks for go-live

🎯 Requirements

• 12+ years of business analysis experience in Medicaid MMIS/MES • Deep hands-on experience in at least two of Claims, Member/Eligibility-Enrollment, and Finance/Financial Accounting • Experience modernizing or replacing legacy MMIS systems using COBOL/mainframe or equivalent with a commercial Medicaid platform • Strong Medicaid domain knowledge, including FFS versus managed care, capitation, ASO, and administrative services models • Knowledge of claim types, media sources, edits/EOBs, adjustments/voids, Medicare crossover, and encounters • Knowledge of aid categories, benefit packages, eligibility spans, timely filing, and TPL concepts • Knowledge of provider payments, remittance advice, budget/object codes, COS, fund source, and FFP concepts • Knowledge of CMS and state Medicaid policy drivers relevant to MES implementation and certification • Ability to write clear functional designs and acceptance criteria for complex adjudication and financial rules • Experience working with development and QA teams in Agile or hybrid SDLC • Excellent facilitation, documentation, and stakeholder communication skills • Hands-on CMdS configuration or implementation preferred • Familiarity with HIPAA X12 (837/835), COBA/crossover, and EVV-related claim flows preferred • Experience supporting CMS MES certification artifacts and evidence packages preferred • Prior lead BA experience on multi-module MES releases preferred • Comfortable owning ambiguity when legacy rules are incomplete and driving decisions with SMEs • Ability to balance policy accuracy with delivery timelines • Credibility with technical teams and business executives • Willingness to travel within the United States • Work authorization and current location required on the application