Jobs via Dice · 3 months ago
Business Analyst- Medicaid Membership (MCO Experience Required)
United States
Full-time
Remote
Senior Level
5+ years expConflux Systems Inc is seeking a Business Analyst with a focus on Medicaid Membership. The role requires expertise in Medicaid operations and systems, particularly in MCO environments, to support and implement membership-related platforms and ensure compliance with regulatory standards.
Computer Software
Responsibilities
Minimum 5+ years working at an MCO or Medicaid-focused environment in business operations and systems
Experience supporting or implementing Medicaid membership SaaS or hosted platforms
Good understanding of MCO operations and systems around Medicaid, MLTC, CHIP, DSNP lines of businesses
Familiarity with work requirement tracking, exemptions, and compliance reporting
Strong understanding of Medicaid membership lifecycle: eligibility, enrollment, disenrollment, premium billing, reconciliation, and reporting
Familiarity with state Medicaid agency interactions (834/820 transactions, roster management, state audits, compliance reporting)
Experience with regulatory compliance and CMS/state Medicaid rules (including work requirements)
Hands-on experience with Medicaid membership systems, portals, or core admin platforms
Knowledge of healthcare data standards (HIPAA, 834, 820, HL7, FHIR) would be a plus
Qualification
Required
Minimum 5+ years working at an MCO or Medicaid-focused environment in business operations and systems
Experience supporting or implementing Medicaid membership SaaS or hosted platforms
Good understanding of MCO operations and systems around Medicaid, MLTC, CHIP, DSNP lines of businesses
Familiarity with work requirement tracking, exemptions, and compliance reporting
Strong understanding of Medicaid membership lifecycle: eligibility, enrollment, disenrollment, premium billing, reconciliation, and reporting
Familiarity with state Medicaid agency interactions (834/820 transactions, roster management, state audits, compliance reporting)
Experience with regulatory compliance and CMS/state Medicaid rules (including work requirements)
Hands-on experience with Medicaid membership systems, portals, or core admin platforms
Preferred
Knowledge of healthcare data standards (HIPAA, 834, 820, HL7, FHIR) would be a plus
Company
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Funding
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