Role Overview
As an Experienced Medicaid Business Analyst, you will serve as the central point of coordination between clients, Managed Care Organizations (MCOs), and internal development teams. Your focus will be on ensuring the smooth operation of Medicaid Management Information System (MMIS) workflows by interpreting business needs, identifying system gaps, and driving solutions that align with regulatory standards.
Key Responsibilities
- Act as the functional bridge between external stakeholders and technical teams, managing communication and expectations across all MMIS-related activities
- Lead sessions to gather and prioritize requirements, especially during periods of high volume in defect reports, change requests, or operational disruptions
- Analyze complex business issues related to Claims (Fee-for-Service and Encounter-based), Financial Management, Capitation, and Provider Enrollment
- Convert policy updates and operational challenges into clear, actionable documentation such as User Stories, Functional Design Documents, and technical specifications
- Verify that proposed technical approaches effectively resolve business requirements prior to development
- Investigate recurring system issues reported by providers or MCOs, including widespread claim rejections, payment discrepancies, or EDI processing failures
- Work closely with operations staff to differentiate between system limitations and training deficiencies, recommending fixes or documentation improvements
- Serve as a subject matter expert on Medicaid processes, ensuring adherence to federal CMS guidelines and local regulatory requirements
- Support compliance initiatives by evaluating how new reporting mandates or data standards affect existing system functionality
Qualifications
- Minimum of 7 years of experience in Business Analysis within Healthcare IT environments
- At least 3 years focused on Medicaid MMIS systems or state-level Eligibility and Enrollment platforms
- Thorough knowledge of core MMIS components including Claims Adjudication, Encounter Processing, Financials, Provider Management, Capitation, and 837/835 EDI transaction flows
- Proven experience using ALM tools such as JIRA, Microfocus ALM, or SharePoint for tracking requirements through the lifecycle
- Familiarity with Agile or hybrid software development methodologies
- Advanced proficiency in Microsoft Excel, including macros, and experience with relational database systems
- Strong presentation and communication skills using tools like PowerPoint
Work Environment
This position offers full remote flexibility for candidates located within the contiguous United States. You will work within a structured yet adaptable framework that supports continuous learning and professional growth.
Compensation and Benefits
The annual salary range for this role is $74,300 to $99,200. Additional offerings include a 401(k) employer match, comprehensive health coverage, generous paid time off, and access to educational development programs. The organization emphasizes career advancement through leadership and technical training academies.
Commitment to Inclusion
This employer is dedicated to equal opportunity and welcomes applicants regardless of race, religion, color, national origin, gender identity, pregnancy status, age, sexual orientation, veteran status, disability, or other protected characteristics under applicable law.
