At Gainwell Technologies, we provide public health services and solutions that make a difference. We are looking for an Experienced Medicaid Business Analyst to be a critical point of contact for our client and external stakeholders, including MCOs and providers. In this role, you will triage complex requirement issues, facilitate high-stakes conversations with state government stakeholders, and translate urgent operational needs into clear, actionable technical specifications for our product teams.

What You'll Do

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 surges in defects, change requests, 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, and Provider Enrollment.
Translate high-level policy changes or operational pain points into detailed User Stories, Functional Design Documents, 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, such as mass claim denials or payment errors.
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 on Medicaid workflows, ensuring compliance with federal Centers for Medicare & Medicaid Services (CMS) and local regulations.
Support the Compliance Manager in assessing the impact of new mandates on current system functionality.

What We're Looking For

7+ years of Business Analysis experience in Healthcare IT.
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, and 837/835 EDI transactions.
Experience with ALM tools such as JIRA, Microfocus ALM, and 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.
Strong PowerPoint and presentation skills.
Understanding of MITA 3.0 framework and CMS-64 financial reporting.
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.

Technical Stack

JIRA
Microfocus ALM
SharePoint
Microsoft Excel
PowerPoint

Team & Environment

You will join a client delivery team supporting the Medicaid Management Information System (MMIS), working with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges.