Senior Business Analyst, MMIS Finance

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee business and functional requirements for the MMIS Financial Management module, covering everything from requirements gathering to implementation and production validation.

• Conduct stakeholder workshops and document existing financial processes.

• Identify gaps in current processes and define the necessary target-state business and system requirements.

• Create requirements, user stories, acceptance criteria, process flows, decision tables, data mappings, interface requirements, and reconciliation rules.

• Examine the entire financial lifecycle, which includes claims payment, payment cycles, warrants and EFT, remittance advice, receivables, recoveries, recoupments, refunds, offsets, voids, reissues, and reconciliation.

• Track claims and financial transactions across adjudication, payment, remittance, banking, general ledger interfaces, and financial reporting.

• Collaborate with finance, program, development, architecture, and QA teams to define screens, work queues, interfaces, batch cycles, and system functionality.

• Maintain requirements traceability, manage backlog priorities and changes to requirements, and address business and testing inquiries.

• Provide support for SIT, UAT, regression testing, defect triage, root-cause analysis, and production validation.

• Ensure reconciliation of payment cycles and financial postings.

• Evaluate the impact of Medicaid policy, regulatory requirements, and CMS reporting.

• Articulate financial concepts and system behaviors to both technical and non-technical stakeholders.

⛳️ Requirements

• Experience as a Business Analyst in Medicaid MMIS/MES, healthcare payer systems, claims payment, or similar financial operations.

• Understanding of claims adjudication, provider payment, accounts payable and receivable, recoveries, adjustments, refunds, offsets, and reconciliation processes.

• Familiarity with 837P, 837I, and 837D transaction sets.

• In-depth knowledge of the 835 transaction, including CAS, PLB, and payment balancing.

• Awareness of Medicare crossover, coordination of benefits, and third-party liability or recovery processes that affect Medicaid payment.

• Proficiency in SQL and X12 validation tools.

• Background in requirements documentation, stakeholder facilitation, traceability, SIT, UAT, defect triage, and production validation.

• Eight or more years of experience in business analysis or healthcare systems, particularly in MMIS financial management or Medicaid payment operations (preferred).

• Familiarity with CMdS or Medicaid enterprise/healthcare payer platforms such as Gainwell, QNXT, HealthRules, or Facets (preferred).

• Knowledge of CMS-64, FMAP, 1099 reporting, MITA Financial Management, X12 820, or NCPDP transactions (preferred).

• Experience with Agile delivery and backlog management tools such as Azure DevOps or Jira (preferred).

🏝️ Benefits

• Health and welfare benefits customized to meet the needs of employees and their families, effective from the first day of employment.

• Retirement savings plan.

• Paid time off.

• Paid holidays.

• Optional dental and vision programs.

• Life and disability insurance.

• Eligibility for bonuses or incentives based on business requirements.

• Opportunity for remote work from home.

• Career growth and advancement opportunities.

• Recognition for an award-winning work environment and a culture of diversity.