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
Act as the primary functional liaison between the client, MCOs, and our internal technical teams for all MMIS operations workflows
Lead requirements gathering sessions and "triage" meetings to address any surges in defects, change requests (CRs), and operational gaps
Manage client expectations regarding system capabilities, timelines for fixes, and regulatory constraints
Analyze and document complex requirement issues namely Claims (FFS & Encounters), Financials, Capitation, Provider Enrollment and others
Validate that proposed technical solutions solve the business problem before development begins
Investigate root causes of systemic issues reported by Providers or MCOs (e.g., mass claim denials, capitation payment errors, EDI rejection loops)
Collaborate with the Operations team to distinguish between "system defects" and "user training gaps," creating workarounds or documentation as needed
Serve as the Subject Matter Expert (SME) on Medicaid workflows, ensuring compliance with federal Centers for Medicare & Medicaid Services (CMS) and local (District) regulations

Requirements

7+ years of Business Analysis experience in Healthcare IT
at least 3 years dedicated to ‘Medicaid MMIS’ or state-level Eligibility & Enrollment systems
Deep understanding of Core MMIS modules: Claims Adjudication, Encounters Processing, Financial Management, Provider Management, MCO Capitation, 837/835 EDI transactions
Experience with ALM tools (JIRA, Microfocus ALM, SharePoint) for requirements traceability
Strong understanding of the SDLC in an Agile/Hybrid environment
Knowledge of Microsoft Excel advanced features such as macros and/or relational database software
Proficient in Powerpoint and presentation skills

Benefits

generous, flexible vacation policy
educational assistance
comprehensive health benefits
401(k) employer match
comprehensive leadership and technical development academies

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

Business AnalysisMedicaid MMISClaims AdjudicationEncounters ProcessingFinancial ManagementProvider ManagementMCO Capitation837 EDI transactions835 EDI transactionsSDLC

Soft Skills

leadershipcommunicationcollaborationproblem-solvingrequirements gatheringclient managementexpectation managementdocumentationanalytical skillspresentation skills