Sr. Business Analyst, Healthcare/HIPAA

Job Description

Job Description

Our client, a leading organization within the public sector healthcare and Medicaid services industry, is seeking an experienced Business Analyst to support a large-scale Medicaid Management Information System (MMIS) environment. This role will focus on provider reimbursement, claims processing, member services, and system enhancements that support healthcare program operations and compliance requirements.

The Business Analyst will collaborate with business stakeholders, technical teams, vendors, and project leadership to support the full system development lifecycle, including requirements gathering, gap analysis, testing, implementation, and post-production stabilization. The ideal candidate will possess strong healthcare domain knowledge, experience with claims processing, and a solid understanding of Medicaid systems and operations.

This position requires excellent analytical, communication, documentation, and stakeholder management skills, as well as the ability to work independently and within cross-functional teams.

Key Responsibilities

• Lead and participate in requirements gathering and Joint Application Design (JAD) sessions with business stakeholders.
• Analyze business processes and identify opportunities for system enhancements and operational improvements.
• Perform gap analysis and document business, functional, and system requirements.
• Support all phases of the Software Development Life Cycle (SDLC), including design, development, testing, implementation, and stabilization.
• Develop test strategies, test scenarios, and test cases based on documented business requirements.
• Execute, review, and validate testing activities, ensuring solutions meet business and regulatory requirements.
• Collaborate with technical teams and vendors to ensure requirements are clearly defined, developed, and tested.
• Prepare and maintain project documentation, process flows, business requirements documents, and functional specifications.
• Support the creation of end-user documentation and training materials.
• Monitor production releases and assist with issue resolution during post-implementation stabilization periods.
• Communicate project updates, risks, and system changes to stakeholders and leadership.
• Participate in stakeholder meetings and represent business analysis functions during project discussions.
• Provide support and guidance regarding MMIS-related inquiries and business processes.
• Perform data analysis and reporting activities to support decision-making and validate business outcomes.
• Serve as a backup resource for other Business Analysts as needed.

Required Qualifications

• Bachelor's degree in Business Administration, Information Technology, Healthcare Administration, or a related field, or equivalent professional experience.
• Minimum of 3 years of Business Analysis experience supporting healthcare, Medicaid, health plan, payer, or claims processing environments.
• Strong understanding of business analysis methodologies and system development lifecycle (SDLC) practices.
• Experience gathering, documenting, and managing business and functional requirements.
• Strong analytical and problem-solving skills with the ability to identify root causes and recommend solutions.
• Proficiency in data analysis and reporting.
• Ability to manage multiple priorities in a fast-paced environment.
• Excellent written and verbal communication skills.
• Strong stakeholder management and interpersonal skills.

Preferred Qualifications

• Experience supporting Medicaid Management Information Systems (MMIS) or other government healthcare programs.
• Knowledge of healthcare claims processing, provider reimbursement, and payment operations.
• Familiarity with HIPAA claims and payment transaction processing.
• Experience working in Agile and/or Waterfall project environments.
• Advanced SQL skills for data querying, validation, and analysis.
• Experience working with third-party vendors and system integrators.
• Understanding of federal and state healthcare regulatory requirements.
• Demonstrated ability to work independently while effectively collaborating with cross-functional teams.

Industry Experience

• Public Sector Healthcare
• Medicaid Programs
• Health Insurance/Payer Operations
• Healthcare Claims Processing