Senior Business Analyst – Medicaid Pharmacy

This is a fully remote position, open to applicants in Illinois, +1 more state.

📋 Description

• Provides support for business, policy, and technical execution across various functional areas within MMIS (Medicaid Management Information Systems) and/or the Medicaid Pharmacy sector.

• Collaborates closely with the Domain Lead, Technical Analysts, and cross-functional teams to ensure effective implementation and operational readiness.

• Ensures compliance by validating that the design and configuration of solutions adhere to CMS guidance, state policies, and established business rules.

• Assists the Domain Lead by conducting analysis, interpretation, and offering solution recommendations.

• Develops and maintains documentation related to domain design, with the Design Document being a key deliverable.

• Aids in operational readiness activities, focusing on environment, data, process, and staffing preparedness.

• Serves as a reliable subject matter expert in the domain and policy, leading client communications, which include requirement discussions, design reviews, and issue resolutions.

⛳️ 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).

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

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

• Strong SQL proficiency is essential, particularly for data analysis and validation tasks.

• Excellent client communication skills, with a track record of direct interaction with business stakeholders.

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

• Strong skills in documentation, facilitation, and analysis.

• Experience working within SDLC and Agile delivery environments.

🏝️ Benefits

• Generous and flexible vacation policy.

• Educational assistance.

• Comprehensive health benefits.

• 401(k) employer match.

• Leadership and technical development academies.