Experienced Medicaid Business Analyst

Business AnalystBusiness AnalystFull TimeRemoteTeam 10,001+H1B SponsorCompany SiteLinkedIn

Location

District of Columbia

Posted

9 days ago

Salary

$74.3K - $99.2K / year

Bachelor Degree7 yrs expEnglishSDLC

Job Description

• 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 • 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 • 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

Job Requirements

  • 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, 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
  • Proficient in Powerpoint and presentation skills

Benefits

  • generous, flexible vacation policy
  • educational assistance
  • comprehensive health benefits
  • 401(k) employer match
  • comprehensive leadership and technical development academies

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