Technical Business Analysis Engineer III, Medicaid

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

📋 Description

• Collaborate with business stakeholders to gather, analyze, and document both business and system requirements.

• Examine suspended claims, operational challenges, and system defects to uncover root causes and propose solutions.

• Work alongside development and QA teams to design, test, and validate enhancements to systems and operational improvements.

• Review updates to Medicaid policies, CMS mandates, and client directives to evaluate their effects on business processes and system functionality.

• Conduct research utilizing billing manuals, design documents, and regulatory guidelines to aid in issue resolution and informed decision-making.

• Document and refine business processes to boost operational efficiency and effectiveness.

• Act as a liaison between business and technical teams throughout the course of the project lifecycle.

• Create test strategies, scenarios, and plans to validate compliance with state policy requirements and payment methodologies.

• Assist in User Acceptance Testing activities and facilitate the implementation of system changes.

• Analyze data and trends to deliver actionable insights and support operational reporting requirements.

⛳️ Requirements

• Experience in interpreting and applying Medicaid policies, CMS regulations, and state healthcare program requirements.

• In-depth knowledge of Medicaid claims processing and payment systems.

• Capability to understand and apply Medicaid payment methodologies in business analysis and testing activities.

• Strong analytical, troubleshooting, and problem-solving abilities.

• Proficient in independently researching and assessing documentation, policies, billing manuals, and technical specifications.

• Excellent communication and collaboration skills with both business and technical stakeholders.

• Ability to handle multiple priorities in a fast-paced environment.

• Over 8 years of experience in the healthcare industry, ideally within the MMIS domain.

• Demonstrated experience supporting large-scale Medicaid systems and operational processes.

• Working knowledge of SQL and relational database concepts.

• Strong skills in presentation, facilitation, and organization.

• Proficient in Microsoft Office applications, including Outlook, Word, and Excel.

• Exceptional written and verbal communication skills with a focus on customer satisfaction.

• Ability to work independently while driving initiatives from analysis through to implementation.

🏝️ 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.

• Opportunities for career advancement.

• Paid time off packages.

• Award-winning workplace culture.

• Comprehensive health insurance coverage.

• Optional dental and vision programs.

• Life and disability insurance.

• Paid holidays.

• PTO or vacation and/or sick leave.

• Option to work remotely from home.