Senior Business Analyst – Provider

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Provide support for business, policy, and technical execution across various functional areas within MMIS and/or the Medicaid Pharmacy sector.

• Convert state and federal Medicaid policies and program requirements into product features, system configurations, business rules, and design documentation.

• Serve as the primary subject matter expert in the domain and a trusted advisor to the Engagement Lead.

• Ensure that solution design and configurations are compliant with CMS guidelines, state policies, and established business rules.

• Assess scope trade-offs along with the functional, regulatory, and operational impacts for negotiations and change management.

• Lead and engage in requirements and design discussions with clients and internal teams.

• Create and update domain design documentation that includes workflows, interfaces, X12 EDI transactions, letters, and reports.

• Verify that requirements and acceptance criteria are precise, complete, and traceable.

• Record and communicate decisions, risks, assumptions, dependencies, and downstream consequences.

• Assist in configuration and implementation tasks across Design, Development, and Implementation phases.

• Set up configurations for claims, plans, providers, members, and pharmacy functional areas.

• Review test cases and offer subject matter expertise during System Integration Testing (SIT) and User Acceptance Testing (UAT).

• Aid in defect analysis, root-cause investigations, resolutions, retesting, and functional readiness validation.

• Support operational readiness, parallel testing, performance testing, cutover planning, transition to operations, and hypercare.

• Collaborate with domain leads, technical teams, and stakeholders.

• Lead and facilitate client interactions, requirements discussions, design evaluations, issue resolution, demonstrations, walkthroughs, working sessions, knowledge transfer, and ongoing operations.

⛳️ Requirements

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

• Over 9 years of practical experience in supporting healthcare system implementations, including MMIS solutions and Medicaid Pharmacy platforms.

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

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

• In-depth knowledge of state and federal Medicaid policies, regulations, and program guidelines.

• Comprehensive understanding of Medicaid domains, including claims, members, providers, and prior authorization processes.

• Experience in translating policy and program guidelines into system requirements, configuration support, and design documentation.

• Proficient in SQL, especially for data analysis and validation.

• Excellent client communication skills with experience engaging directly with business stakeholders.

• Experience in leading or supporting functional demonstrations, walkthroughs, and collaborative working sessions.

• Strong documentation, facilitation, and analytical capabilities.

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

• Knowledge of MITA is a plus.

• Experience with system integrations, EDI/X12 transactions, analytics, and reporting is a plus.

• Familiarity with state and federal healthcare regulations and compliance standards is an advantage.

🏝️ Benefits

• Flexible work arrangements.

• Opportunities for learning and career advancement.

• Flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefits.

• Educational support.

• Leadership and technical development academies.