Experienced Business Analyst - Provider +
Location
United States
Posted
3 days ago
Salary
$86.8K - $124K / year
Seniority
Mid Level
No structured requirement data.
Job Description
Experienced Business Analyst - Provider +
Gainwell Technologies
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.
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