Business Analyst – MMIS, Medicaid Pharmacy

Gainwell Technologies

. 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 .

Posted 4/23/2026full-timeRemote • District of Columbia • 🇺🇸 United StatesMid-LevelSenior💰 $86,800 - $124,000 per yearWebsite

Tech Stack

Tools & technologies

SDLCSQL

About the role

Key responsibilities & impact

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
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
Develop and maintain domain design documentation, with the Design Document as a core deliverable, covering workflows, interfaces, X12 EDI transactions, letters, and reports
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 defect analysis, root-cause investigation, resolution, retesting, and functional readiness validation
Collaborate with the Domain Lead and Technical Analysts, acting as a trusted domain and policy SME

Requirements

What you’ll need

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.

Benefits

Comp & perks

Comprehensive health benefits
401(k) employer match
Generous, flexible vacation policy
Educational assistance
Leadership and technical development academies

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

MMISMedicaid PharmacyQNXTSQLX12 EDISystem Integration TestingUser Acceptance Testingdata analysisconfiguration supportdesign documentation

Soft Skills

client communicationcollaborative workingdocumentationfacilitationanalytical skillsleadershipnegotiationproblem-solvinginterpersonal skillsorganizational skills

Certifications

Bachelor’s degree in Computer ScienceBachelor’s degree in Information SystemsBachelor’s degree in Health Informatics