Apply on Employer Site

Gainwell Technologies · 11 hours ago

Advisor Business Analyst - Medicaid

District of Columbia, United States

Full-time

Hybrid

Senior Level, Lead/Staff

$93K/yr - $133K/yr

9+ years exp

Gainwell Technologies is dedicated to improving the health and well-being of vulnerable communities through innovative technology solutions. As an Advisor Business Analyst - Medicaid, you will serve as a key liaison for client delivery, addressing complex Medicaid operational needs and facilitating communication between clients and internal teams.

Health CareInformation Technology

Responsibilities

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

Translate high-level policy changes or operational pain points into detailed User Stories, Functional Design Documents (FDDs), and Technical Specifications for developers

Validate 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 (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

Qualification

Medicaid MMIS expertiseRequirements engineeringALM tools proficiencySDLC understandingMicrosoft Excel advanced featuresClient-facing confidenceCrisis managementProblem-solving curiosityInterpersonal skillsTeam leadership

Required

9+ years of Business Analysis experience in Healthcare IT, with at least 4 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

PowerPoint and presentation skills

Proven ability to lead meetings with government clients and push back diplomatically when necessary

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

Must be available to work 8a-5p eastern time to support client hours

Opportunities to travel through your work (0-10%)

Fully remote options from most US locations and territories

Video cameras must be used during all interviews, as well as during the initial week of orientation