Senior Business Analyst – Provider

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

📋 Description

• Assisting in business, policy, and technical implementations across various functional areas within MMIS Medicaid Management Information Systems (MMIS) and/or the Medicaid Pharmacy sector.

• Ensuring that solutions are consistent with CMS guidance, state policies, and established business rules.

• Leading and engaging in requirements and design discussions with clients and internal teams to confirm functional and technical requirements.

• Analyzing federal and state Medicaid policies and converting them into system configurations, product features, business rules, and design documentation.

• Creating and maintaining domain design documentation, which includes a detailed Design Document outlining workflows, interfaces, X12 EDI transactions, letters, and reports.

• Facilitating operational readiness across various environments, data sets, processes, and staffing.

⛳️ Requirements

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

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

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

• In-depth knowledge of state and federal Medicaid policies, regulations, and program rules is essential.

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

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

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

• Excellent client communication skills, with a track record of engaging directly with business stakeholders.

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

• Strong documentation, facilitation, and analytical abilities.

• Experience in working within SDLC and Agile delivery frameworks.

🏝️ Benefits

• Generous and flexible vacation policy.

• Educational assistance.

• Comprehensive health benefits.

• 401(k) employer match.

• Leadership and technical development academies.