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Gainwell Technologies logo
Gainwell Technologies

Gainwell Technologies is an award-winning digital health technology company that supports the administration of healthcare and human services programs. In past

Experienced Medicaid Business Analyst

Location

United States

Posted

107 days ago

Salary

0

No structured requirement data.

Job Description

Experienced Medicaid Business Analyst

Gainwell Technologies

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description As a Experienced Medicaid Business Analyst at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. - Act as the primary functional liaison between the client, MCOs, and our internal technical teams for all MMIS operations workflows - Lead requirements gathering sessions and "triage" meetings to address any surges in defects, change requests (CRs), and operational gaps - Manage client expectations regarding system capabilities, timelines for fixes, and regulatory constraints - Analyze and document complex requirement issues namely Claims (FFS & Encounters), Financials, Capitation, Provider Enrollment and others - Translate high-level policy changes or operational pain points into detailed User Stories, Functional Design Documents (FDDs), and Technical Specifications for developers - Validate that proposed technical solutions solve the business problem before development begins - Investigate root causes of systemic issues reported by Providers or MCOs (e.g., mass claim denials, capitation payment errors, EDI rejection loops) - Collaborate with the Operations team to distinguish between "system defects" and "user training gaps," creating workarounds or documentation as needed - Serve as the Subject Matter Expert (SME) on Medicaid workflows, ensuring compliance with federal Centers for Medicare & Medicaid Services (CMS) and local (District) regulations - Support the Compliance Manager in assessing the impact of new mandates (e.g., 1095-B reporting, T-MSIS data quality) on current system functionality - Understanding of MITA 3.0 framework and CMS-64 financial reporting Qualifications - 7+ years of Business Analysis experience in Healthcare IT, with at least 3 years dedicated to ‘Medicaid MMIS’ or state-level Eligibility & Enrollment systems - Deep understanding of Core MMIS modules: Claims Adjudication, Encounters Processing, Financial Management, Provider Management, MCO Capitation, 837/835 EDI transactions - Experience with ALM tools (JIRA, Microfocus ALM, SharePoint) for requirements traceability - Strong understanding of the SDLC in an Agile/Hybrid environment - Knowledge of Microsoft Excel advanced features such as macros and/or relational database software - Powerpoint and presentation skills Requirements - Proven ability to lead meetings with government clients and push back diplomatically when necessary - Ability to remain calm and structured during "surge" periods of high-volume issues and reporting - Curiosity to solve complex problems and strong interpersonal skills to interact with and influence clients and team members - A caring team leader who motivates and coaches less experienced resources Benefits - Generous, flexible vacation policy - 401(k) employer match - Comprehensive health benefits - Educational assistance - Leadership and technical development academies to help build your skills and capabilities

Job Requirements

  • 7+ years of Business Analysis experience in Healthcare IT, with at least 3 years dedicated to ‘Medicaid MMIS’ or state-level Eligibility & Enrollment systems
  • Deep understanding of Core MMIS modules: Claims Adjudication, Encounters Processing, Financial Management, Provider Management, MCO Capitation, 837/835 EDI transactions
  • Experience with ALM tools (JIRA, Microfocus ALM, SharePoint) for requirements traceability
  • Strong understanding of the SDLC in an Agile/Hybrid environment
  • Knowledge of Microsoft Excel advanced features such as macros and/or relational database software
  • Powerpoint and presentation skills
  • Proven ability to lead meetings with government clients and push back diplomatically when necessary
  • Ability to remain calm and structured during "surge" periods of high-volume issues and reporting
  • Curiosity to solve complex problems and strong interpersonal skills to interact with and influence clients and team members
  • A caring team leader who motivates and coaches less experienced resources

Benefits

  • Generous, flexible vacation policy
  • 401(k) employer match
  • Comprehensive health benefits
  • Educational assistance
  • Leadership and technical development academies to help build your skills and capabilities

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