Experienced Provider+ Business Analyst - MMIS / Medicaid Pharmacy

Role Description

As an Experienced Provider+ Business Analyst - MMIS / Medicaid Pharmacy at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges.

The Experienced Provider+ Business Analyst supports business, policy, and technical execution across one or more functional domains within MMIS Medicaid Management Information Systems (MMIS) and/or the Medicaid Pharmacy environment. Supported domains may include:

• Member
• Provider
• Claims (Medicaid, Dental and/or Pharmacy)
• Finance
• Plan and Care Management
• Business Relationship Management

This role supports end‑to‑end domain delivery by translating state and federal Medicaid policy and program requirements into product features, system configuration, and design artifacts. The Business Analyst works closely with the Domain Lead, Technical Analysts, and cross‑functional teams and acts as a domain and policy subject-matter expert (SME) to ensure successful implementation and operational readiness.

Qualifications

• Bachelor’s degree in Computer Science, Information Systems, Health Informatics, or a related field.
• 5 to 8 years of hands-on experience supporting healthcare system implementations, including MMIS solutions and Medicaid Pharmacy platforms.
• Experience with QNXT or similar healthcare claims/encounter management systems.
• Strong knowledge of state and federal Medicaid policy, regulations, and program rules.
• Strong understanding of Medicaid domains, including claims, member, provider, and prior authorization processes.
• Demonstrated experience translating policy and program rules into system requirements, configuration support, and design artifacts.
• Strong knowledge of SQL, particularly for data analysis and validation.
• Strong client communication skills, with experience interacting directly with business stakeholders.
• Proven ability to lead or support functional demonstrations, walkthroughs, and collaborative working sessions.
• Strong documentation, facilitation, and analytical skills.
• Experience working in SDLC and Agile delivery environments.

Requirements

• Acts as the primary Domain SME, serving as a trusted advisor to the Engagement Lead (EL) on business processes and associated regulatory and operational impacts.
• Ensures compliance alignment by validating that solution design and configuration conform to CMS guidance, state policy, and documented business rules.
• Supports the EL with in-scope negotiations and change control, providing domain expertise to assess scope trade-offs and the functional, regulatory, and operational impacts of change requests.
• Lead and participate in collaborative requirements and design sessions with clients and internal teams to validate functional and technical needs.
• Interpret state and federal Medicaid policy, regulations, and program rules and translate them into product features, system configuration, business rules, and design artifacts.
• Develop and maintain domain design documentation, with the Design Document as a core deliverable, covering workflows, interfaces, X12 EDI transactions, letters, and reports.
• Ensure accuracy, completeness, and traceability of requirements and acceptance criteria.
• Document and communicate domain-level decisions, risks, assumptions, and dependencies, assessing downstream impacts.
• Support domain-specific configuration and implementation activities within Design, Development, and Implementation (DDI) projects.
• Responsible for configuration and partner with technical teams to ensure solutions align with approved design documentation, Medicaid policy interpretation, and documented business rules.
• Review test cases to ensure alignment with requirements, policy interpretation, and acceptance criteria.
• Provide domain SME support during System Integration Testing (SIT) and User Acceptance Testing (UAT).
• Support operational readiness activities, including environment, data, process, and staffing readiness.
• Work closely with the Domain Lead and Technical Analysts, acting as a trusted domain and policy SME.
• Lead and support client communication, including requirement discussions, design reviews, and issue resolution.

Benefits

• Fully remote options from Contiguous US locations only.
• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Leadership and technical development academies to help build your skills and capabilities.