S2Tech

Business Analyst

• Lead requirements gathering, analysis, documentation, and validation activities for MMIS modernization initiatives with a primary focus on Claims Processing
• Facilitate Joint Application Design (JAD) sessions and working sessions with state stakeholders, business teams, technical teams, and vendors
• Translate complex business needs into clear, structured, and testable business requirements using established business analysis methodologies
• Track requirements from initial scope definition through refinement, validation, implementation, and testing support
• Conduct current-state versus future-state gap analysis and recommend modernization approaches aligned with Commonwealth objectives
• Ensure requirements traceability throughout the Software Development Life Cycle (SDLC)
• Support defect triage, operational impact analysis, issue resolution, and change management activities
• Partner closely with development and QA teams to ensure business intent is accurately implemented
• Lead analysis activities supporting modernization of the MMIS Claims Processing solution, including:
• - Claims intake and submission workflows
• - Claims editing and validation
• - Claims adjudication and pricing
• - Payment processing and financial disposition
• - Denials, suspensions, adjustments, and voids
• - Coordination of Benefits (COB)
• - Third Party Liability (TPL)
• - Managed Care encounter processing
• - Provider reimbursement methodologies
• - Claims lifecycle reporting and operational monitoring
• Analyze and document business requirements supporting multiple claim submission channels, including:
• - Provider Web Portal
• - Electronic Data Interchange (EDI)
• - X12 transaction processing
• - Batch file interfaces
• - Clearinghouse integrations
• - System-to-system interfaces
• Develop business requirements supporting the processing of standard healthcare transactions, including:
• - 837 Institutional (837I)
• - 837 Professional (837P)
• - 837 Dental (837D)
• - 835 Electronic Remittance Advice
• - 270/271 Eligibility Inquiry & Response
• - 276/277 Claim Status Inquiry & Response
• - Other HIPAA-compliant X12 transactions supporting Medicaid operations
• Collaborate with business and technical teams to analyze:
• - Claims editing rules
• - Benefit and policy validation
• - Payment logic
• - Pricing methodologies
• - Provider reimbursement
• - Financial reconciliation
• - Exception handling
• - Operational workflows
• Produce comprehensive Business Requirements Documents (BRDs) including:
• - Business background and objectives
• - Current-state and future-state business processes
• - Claims workflow analysis
• - Business rules
• - Detailed business requirements
• - Operational impacts and dependencies
• - Assumptions
• - Key decisions
• - Open issues
• - Testing considerations
• - Validation scenarios
• Develop:
• - Process flows
• - Decision trees
• - Use cases
• - Decision tables
• - Data mapping documentation
• - Interface specifications
• - Business rules catalogs
• - Workflow diagrams
• Maintain high-quality documentation standards across all deliverables
• Leverage AI tools and prompt engineering techniques to support requirements generation, business analysis activities, and documentation development
• Create and refine AI prompts to improve the quality and efficiency of requirements-related deliverables
• Evaluate AI-generated output for accuracy, completeness, consistency, and business relevance
• Apply critical thinking and business judgment when utilizing AI-assisted analysis techniques
• Build strong working relationships with client stakeholders, project leadership, and cross-functional teams
• Facilitate productive discussions and diplomatically challenge unclear or incomplete requirements when necessary
• Communicate complex business and technical concepts effectively to both technical and non-technical audiences
• Anticipate downstream impacts, risks, dependencies, financial implications, and operational considerations associated with requirements decisions
• Operate independently as a self-starter while contributing to broader modernization program objectives

Senior Business Analyst – MMIS Claims Processing

Software Engineer

• Design, code, test, and maintain COBOL programs for mainframe applications
• Work with mainframe systems and associated technologies to ensure optimal performance and reliability
• Analyze business requirements and system specifications to develop effective and efficient COBOL solutions. Identify and troubleshoot issues, providing timely resolutions
• Collaborate with cross-functional teams, including business analysts, systems analysts, and other developers, to ensure seamless integration of COBOL applications within the broader IT ecosystem
• Create and maintain comprehensive documentation for all COBOL programs, ensuring clarity and ease of understanding for other team members
• Conduct thorough unit testing of developed code to ensure its functionality, reliability, and compliance with established standards
• Identify opportunities for performance optimization and implement necessary improvements to enhance the overall efficiency of COBOL applications

Senior Business Analyst – MMIS Claims Processing

Mainframe Developer