Senior Medicaid Business Analyst – Configuration, Policy

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

📋 Description

• Assist in the execution of business, policy, and technical initiatives across various functional areas within MMIS and/or Medicaid Pharmacy settings.

• Convert state and federal Medicaid policies and program specifications into product functionalities, system configurations, business rules, and design documents.

• Act as the main subject-matter expert in domain and policy matters and a trusted advisor to the Engagement Lead.

• Ensure solution designs and configurations comply with CMS guidelines, state policies, and established business rules.

• Aid in scope negotiations and change management by evaluating functional, regulatory, and operational implications.

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

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

• Record and communicate decisions, risks, assumptions, dependencies, and potential downstream effects at the domain level.

• Assist in domain-specific configuration and implementation tasks within Design, Development, and Implementation projects.

• Collaborate with technical teams to ensure configurations are in line with approved designs, policy interpretations, and business rules.

• Evaluate test cases and offer subject-matter expertise during System Integration Testing and User Acceptance Testing.

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

• Support operational readiness including environment/data/process/staffing preparations, operational readiness reviews, parallel testing, performance testing, cutover, transition to operations, and hypercare.

• Lead and facilitate client communications, functional demonstrations, solution walkthroughs, and joint working sessions.

• Assist in documentation, knowledge transfer, and ongoing operational support.

⛳️ 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 similar healthcare provider/claims management systems.

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

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

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

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

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

• Capable of leading or assisting in functional demonstrations, walkthroughs, and collaborative working sessions.

• Strong skills in documentation, facilitation, and analysis.

• Experience in SDLC and Agile delivery environments.

• Knowledge of MITA (Medicaid Information Technology Architecture) is preferred.

• Familiarity with system integrations, EDI/X12 transactions, analytics, and reporting is preferred.

• Understanding of state and federal healthcare regulations and compliance standards is preferred.

🏝️ Benefits

• Fully remote options available from most US locations and territories.

• Flexible working conditions.

• Opportunities for learning and career advancement.

• Generous and flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.

• Commitment to equal opportunity employment.