Experienced Business Analyst – MMIS, Medicaid Pharmacy

This is a fully remote position, open to applicants in District of Columbia.

📋 Description

• Provides support for business, policy, and technical implementation within MMIS Medicaid Management Information Systems and/or the Medicaid Pharmacy sector.

• Serves as the primary Subject Matter Expert (SME), acting as a reliable advisor on business processes and their regulatory and operational implications.

• Ensures adherence to compliance by verifying that solution design and configurations align with CMS guidelines, state policies, and established business rules.

• Assists the Executive Leadership in negotiations and change control relevant to the scope, offering domain expertise to evaluate trade-offs and the functional, regulatory, and operational impacts of change requests.

• Leads and engages in collaborative sessions for requirements and design with clients and internal teams to confirm functional and technical requirements.

• Analyzes state and federal Medicaid policies, regulations, and program rules, translating them into product features, system configurations, business rules, and design documents.

• Develops and maintains documentation for domain design, ensuring requirements and acceptance criteria are accurate, complete, and traceable.

• Aids in operational readiness activities and client interactions, including discussions on requirements, design evaluations, and problem resolution.

⛳️ Requirements

• Bachelor’s degree in Computer Science, Information Systems, Health Informatics, or a related discipline.

• 5 to 8 years of practical experience in supporting healthcare system implementations, including MMIS solutions and Medicaid Pharmacy platforms.

• Familiarity with QNXT or comparable healthcare claims/encounter management systems.

• In-depth knowledge of state and federal Medicaid policies, regulations, and program rules (mandatory).

• Strong understanding of Medicaid domains, including claims, member, provider, and prior authorization processes.

• Proven experience in converting policy and program rules into system requirements, configuration support, and design documents.

• Proficient in SQL, particularly for data analysis and validation tasks.

• Excellent client communication abilities, with experience engaging directly with business stakeholders.

• Demonstrated capacity to lead or assist in functional demonstrations, walkthroughs, and collaborative working sessions.

• Strong skills in documentation, facilitation, and analysis.

• Experience in Software Development Life Cycle (SDLC) and Agile delivery methodologies.

🏝️ Benefits

• Generous, flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.