Business Analyst - Medicaid

Summary

As a Business Analyst - Medicaid 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.

We are seeking an experienced Medicaid Business Analyst to join our client delivery team supporting the Medicaid Management Information System (MMIS). While supporting operational execution of Medicaid workflow, this role will serve as a critical point of contact for our client and external stakeholders including MCOs, Providers and third parties. You will be the "front line" for triaging complex requirement issues, facilitating high-stakes conversations with state government stakeholders, and translating urgent operational needs into clear, actionable technical specifications for our internal product teams. The role requires active leadership, rapid problem-solving, and deep domain expertise in Medicaid workflows.

Your role in our mission

Client Liaison & Stakeholder Management

• 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.

Requirements Engineering

• Analyze and document complex requirement issues namely Claims (FFS & Encounters), Financials, Capitation, Provider Enrollment and others.
• Translate high-level policy changes or operational pain points into detailed User Stories, Functional Design Documents (FDDs), and Technical Specifications for developers.
• Validate that proposed technical solutions solve the business problem before development begins.

.... your role continued

Requirement issue resolutions

• 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.

Domain Leadership

• Serve as the Subject Matter Expert (SME) on Medicaid workflows, ensuring compliance with federal Centers for Medicare & Medicaid Services (CMS) and local (District) regulations.
• Support the Compliance Manager in assessing the impact of new mandates (e.g., 1095-B reporting, T-MSIS data quality) on current system functionality.
• Understanding of MITA 3.0 framework and CMS-64 financial reporting.

What we're looking for

• 5+ years of Business Analysis experience in Healthcare IT, with at least 2 years dedicated to ‘Medicaid MMIS’ (including CMS) or state-level Eligibility & Enrollment systems.
• Domain knowledge
  • Deep understanding of Core MMIS modules: Claims Adjudication, Encounters Processing, Financial Management, Provider Management, MCO Capitation, 837/835 EDI transactions.
• Technical proficiency
  • 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
  • Powerpoint and presentation skills

Soft Skills

• Client-Facing Confidence: Proven ability to lead meetings with government clients and push back diplomatically when necessary.
• Crisis Management: Ability to remain calm and structured during "surge" periods of high-volume issues and reporting.
• Curiosity to solve complex problems and strong interpersonal skills to interact with and influence clients and team members
• A caring team leader who motivates and coaches less experienced resources

What you should expect in this role

• Fully remote options from Contiguous US locations only
• Office Hours: 8a - 5p Eastern time
• Opportunities to travel through your work (0-10%)
• Video cameras must be used during all interviews, as well as during the initial week of orientation

• The deadline to submit applications for this posting is March 10, 2026

• #LI-HC1
• #LI-Medicaid MMIS