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