Senior or Advisor Business Analyst

Role Description

As a Senior or Advisor Business Analyst - Provider+ 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.

These positions support 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

These roles support 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

• 5 to 8 years of hands-on experience supporting healthcare system implementations, including MMIS solutions and Medicaid Pharmacy platforms.
• 9+ years of hands-on experience supporting healthcare system implementations, including MMIS solutions and Medicaid Pharmacy platforms.
• Bachelor’s degree in Computer Science, Information Systems, Health Informatics, or a related field.
• 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 Subject Matter Expert (SME) and trusted advisor to the Engagement Lead (EL), providing guidance on business processes and regulatory/operational impacts.
• Ensures solution design and configuration align with CMS guidance, state policy, and documented business rules.
• Supports in-scope negotiations and change control by evaluating scope trade-offs and associated functional, regulatory, and operational impacts.
• Leads and participates in requirements and design sessions with clients and internal teams to validate business and technical needs.
• Interprets federal and state Medicaid policy, translating it into product features, system configurations, business rules, and design artifacts.
• Serves as a domain SME, supporting analysis, interpretation, and solution recommendations.
• Develops and maintains domain design documentation covering workflows, interfaces, X12 EDI transactions, letters, and reports.
• Ensures requirements and acceptance criteria are accurate, complete, and traceable.
• Documents and communicates decisions, risks, assumptions, and dependencies, including downstream impacts.

Benefits

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