Senior Business Analyst - Medicaid Pharmacy (MMIS)

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary

As a  Senior Business Analyst - Medicaid Pharmacy (MMIS) 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. Here are the details on this position.

The  Senior 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, and 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 to ensure successful implementation and operational readiness.

Your role in our mission

Requirements & Design
Ensures compliance alignment by validating that solution design and configuration adhere to CMS guidance, state policy, and documented business rules. Supports the Engagement Lead (EL) in scope negotiations and change control, providing domain expertise to evaluate trade-offs and assess functional, regulatory, and operational impacts of change requests. Leads and participates in collaborative requirements and design sessions with clients and internal teams. Interprets Medicaid policy, regulations, and program rules, translating them into product features, system configurations, and design artifacts.

Partners with the Domain Lead to provide analysis, interpretation, and solution recommendations. Develops and maintains comprehensive design documentation—centered on the Design Document—covering workflows, interfaces, X12 EDI transactions, letters, and reports. Ensures requirements and acceptance criteria are accurate, complete, and traceable. Documents and communicates key decisions, risks, assumptions, and dependencies, including downstream impacts.

Build / Configuration
Supports domain-specific configuration and implementation within DDI projects. Responsible for configuring solutions and collaborating with technical teams to ensure alignment with approved designs, Medicaid policy interpretations, and business rules. Key configuration areas include:

• Claims: edits, pricing, benefit limits, adjudication logic
• Plan: contracts, benefits, programs, fee schedules
• Provider: types, specialties, enrollment, credentialing, contracts
• Member: eligibility, demographics, benefit plans
• Pharmacy: Rx benefits and claims processing

Testing
Reviews test cases to ensure alignment with requirements, policy interpretation, and acceptance criteria. Provides SME support during System Integration Testing (SIT) and User Acceptance Testing (UAT). Assists with defect analysis, root-cause investigation, resolution, retesting, and validation of functional readiness.

Operational Readiness & Deployment
Supports operational readiness, including environment, data, process, and staffing preparation. Contributes domain and policy input to Operational Readiness Reviews (ORR), parallel testing, and performance testing. Assists with cutover planning, transition to operations, and hypercare support.

Collaboration & Client Engagement
Works closely with the Domain Lead and Technical Analysts as a trusted domain and policy SME. Leads and supports client engagement activities, including requirements discussions, design reviews, and issue resolution. Plans and delivers functional demos and solution walkthroughs to validate alignment with client needs. Facilitates collaborative sessions with stakeholders and cross-functional teams. Supports documentation, knowledge transfer, and ongoing operational support.

What we're looking for

• 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 (required).
• 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 is required , 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.

What sets you apart

• Knowledge of  MITA (Medicaid Information Technology Architecture) .
• Experience with system integrations, EDI/X12 transactions, analytics, and reporting.
• Familiarity with state and federal healthcare regulations and compliance standards.

What you should expect in this role

• Fully remote options from Contiguous US locations only

• Video cameras must be used during all interviews, as well as during the initial week of orientation
• This posting is intended for pipelining. This is a developing position therefore the job description is subject to change.

#LI-HC1

#LI-MMIS

#LI-Medicaid Pharmacy

The pay range for this position is $69,400 - $99,200 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our and visit our for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.