• Eliciting, analyzing and documenting requirements for improving, replacing or creating new processes and systems • Designing end-to-end, scalable business processes including controls and metrics to measure and manage process efficiency and effectiveness • Collaborating with and supporting technical staff in enhancing or developing new solutions • Preparing and executing test strategies, plans and matrices for new systems, processes or enhancements • Provide support to business users and systems management in addressing complex business issues, documenting business cases, assessing risks, presenting recommendations to business users and management, implementing solutions

• Lead business analysis activities supporting solution design, configuration, implementation, testing, and deployment. • Conduct stakeholder interviews, workshops, Joint Application Design (JAD) sessions, discovery meetings, and business process reviews. • Elicit, analyze, document, validate, and manage business, functional, technical, and non-functional requirements. • Collaborate with architects, developers, testers, and configuration teams to clarify requirements and resolve issues.

• Analyze data trends to identify patterns and recommend cost-saving initiatives and productivity improvements • Identify and drive opportunities to improve performance against contractual terms and service level agreements • Review financial performance, track variances against budget, and present actionable recommendations to senior management to reduce costs and increase revenue • Analyze client data to uncover trends aligned with key client priorities and evolving industry dynamics • Deliver accurate and timely monthly, quarterly, and ad hoc reporting; ensure data integrity and quality assurance across all outputs • Drive automation and process improvements to enhance efficiency in report generation and data delivery

Role Description As an Experienced Business Analyst - Provider + 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. This role supports end‑to‑end domain delivery by translating state and federal Medicaid policy and program requirements into product features, system configuration, and design artifacts. - Supports business, policy, and technical execution across one or more functional domains within MMIS Medicaid Management Information Systems (MMIS) and/or the Medicaid Pharmacy environment. - Acts as the primary Domain SME, serving as a trusted advisor to the Engagement Lead (EL) on business processes and associated regulatory and operational impacts. - Ensures compliance alignment by validating that solution design and configuration conform to CMS guidance, state policy, and documented business rules. - Supports the EL with in‑scope negotiations and change control, providing domain expertise to assess scope trade‑offs and the functional, regulatory, and operational impacts of change requests. - Leads and participates in collaborative requirements and design sessions with clients and internal teams to validate functional and technical needs. - Interprets state and federal Medicaid policy, regulations, and program rules and translates them into product features, system configuration, business rules, and design artifacts. - Develops and maintains domain design documentation, with the Design Document as a core deliverable, covering workflows, interfaces, X12 EDI transactions, letters, and reports. - Ensures accuracy, completeness, and traceability of requirements and acceptance criteria. - Documents and communicates domain‑level decisions, risks, assumptions, and dependencies, assessing downstream impacts. - Supports domain-specific configuration and implementation activities within Design, Development, and Implementation (DDI) projects. - Responsible for configuration and partners with technical teams to ensure solutions align with approved design documentation, Medicaid policy interpretation, and documented business rules. - Reviews test cases to ensure alignment with requirements, policy interpretation, and acceptance criteria. - Provides domain SME support during System Integration Testing (SIT) and User Acceptance Testing (UAT). - Supports operational readiness activities, including environment, data, process, and staffing readiness. - Works closely with the Domain Lead and Technical Analysts, acting as a trusted domain and policy SME. - Plans and delivers functional demos and solution walkthroughs to showcase product features and validate alignment with client requirements. Qualifications - 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. - 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, 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. Requirements - Knowledge of MITA (Medicaid Information Technology Architecture). - Experience with system integrations, EDI/X12 transactions, analytics, and reporting. - Familiarity with state and federal healthcare regulations and compliance standards. Benefits - Fully remote options from Contiguous US locations only. - 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.