Providing specialized IT and Business services to both government and private customers.
Senior Business Analyst – MMIS Claims Processing
Location
Missouri
Posted
3 days ago
Salary
0
Seniority
Senior
Job Description
Senior Business Analyst – MMIS Claims Processing
S2Tech
• Lead requirements gathering, analysis, documentation, and validation activities for MMIS modernization initiatives with a primary focus on Claims Processing • Facilitate Joint Application Design (JAD) sessions and working sessions with state stakeholders, business teams, technical teams, and vendors • Translate complex business needs into clear, structured, and testable business requirements using established business analysis methodologies • Track requirements from initial scope definition through refinement, validation, implementation, and testing support • Conduct current-state versus future-state gap analysis and recommend modernization approaches aligned with Commonwealth objectives • Ensure requirements traceability throughout the Software Development Life Cycle (SDLC) • Support defect triage, operational impact analysis, issue resolution, and change management activities • Partner closely with development and QA teams to ensure business intent is accurately implemented • Lead analysis activities supporting modernization of the MMIS Claims Processing solution, including: - Claims intake and submission workflows - Claims editing and validation - Claims adjudication and pricing - Payment processing and financial disposition - Denials, suspensions, adjustments, and voids - Coordination of Benefits (COB) - Third Party Liability (TPL) - Managed Care encounter processing - Provider reimbursement methodologies - Claims lifecycle reporting and operational monitoring • Analyze and document business requirements supporting multiple claim submission channels, including: - Provider Web Portal - Electronic Data Interchange (EDI) - X12 transaction processing - Batch file interfaces - Clearinghouse integrations - System-to-system interfaces • Develop business requirements supporting the processing of standard healthcare transactions, including: - 837 Institutional (837I) - 837 Professional (837P) - 837 Dental (837D) - 835 Electronic Remittance Advice - 270/271 Eligibility Inquiry & Response - 276/277 Claim Status Inquiry & Response - Other HIPAA-compliant X12 transactions supporting Medicaid operations • Collaborate with business and technical teams to analyze: - Claims editing rules - Benefit and policy validation - Payment logic - Pricing methodologies - Provider reimbursement - Financial reconciliation - Exception handling - Operational workflows • Produce comprehensive Business Requirements Documents (BRDs) including: - Business background and objectives - Current-state and future-state business processes - Claims workflow analysis - Business rules - Detailed business requirements - Operational impacts and dependencies - Assumptions - Key decisions - Open issues - Testing considerations - Validation scenarios • Develop: - Process flows - Decision trees - Use cases - Decision tables - Data mapping documentation - Interface specifications - Business rules catalogs - Workflow diagrams • Maintain high-quality documentation standards across all deliverables • Leverage AI tools and prompt engineering techniques to support requirements generation, business analysis activities, and documentation development • Create and refine AI prompts to improve the quality and efficiency of requirements-related deliverables • Evaluate AI-generated output for accuracy, completeness, consistency, and business relevance • Apply critical thinking and business judgment when utilizing AI-assisted analysis techniques • Build strong working relationships with client stakeholders, project leadership, and cross-functional teams • Facilitate productive discussions and diplomatically challenge unclear or incomplete requirements when necessary • Communicate complex business and technical concepts effectively to both technical and non-technical audiences • Anticipate downstream impacts, risks, dependencies, financial implications, and operational considerations associated with requirements decisions • Operate independently as a self-starter while contributing to broader modernization program objectives
Job Requirements
- Strong experience as a Business Analyst supporting MMIS/MES or Medicaid modernization initiatives
- Direct experience supporting MMIS Claims Processing
- Strong understanding of the complete Medicaid claims lifecycle from submission through adjudication, payment, adjustment, and financial reconciliation
- Experience with claims editing, pricing, adjudication logic, payment methodologies, and business rules
- Experience working with HIPAA X12 healthcare transaction standards
- Experience supporting electronic claims processing and multiple claim intake channels
- Strong preference for candidates with CLIENT-SIDE MMIS experience (state agency/business operations perspective) versus solely vendor-module implementation experience
- Demonstrated experience facilitating stakeholder sessions, JAD workshops, and executive-level business discussions
- Proven experience producing high-quality BUSINESS requirements (not solely functional or technical requirements)
- Deep understanding of:
- Requirements gathering and validation
- Business process analysis
- SDLC methodologies
- Gap analysis
- Medicaid claims operations
- Claims adjudication business rules
- Healthcare payment processing
- Medicaid policy-driven systems
- Strong verbal and written communication skills with close attention to detail
- Ability to manage ambiguity and operate effectively within large-scale enterprise modernization efforts
Benefits
- Medical / Dental / Vision Insurance – insurance premium assistance provided
- Additional Insurance (Life, Disability, etc.)
- Paid Time Off
- 401(k) Retirement Savings Plan & Health Savings Account
- Various training courses to promote continuous learning
- Corporate Wellness Program
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