Gainwell Technologies · 1 week ago
Business Analyst - Medicaid MMIS
United States
Full-time
Remote
Mid, Senior Level
$60K/yr - $79K/yr
5+ years expGainwell Technologies is dedicated to improving the health and well-being of vulnerable communities through innovative technology solutions. The Business Analyst - Medicaid MMIS will act as a crucial liaison between clients and technical teams, managing operational workflows and translating complex requirements into actionable specifications.
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 that 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
Understanding of MITA 3.0 framework and CMS-64 financial reporting
Qualification
Required
5+ years of Business Analysis experience in Healthcare IT, with at least 2 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
Benefits
Generous, flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Company
Gainwell Technologies
Gainwell Technologies is a provider of Information Technology & Services. It is a sub-organization of Veritas Capital.
10001+ employees
H1B Sponsorship
Gainwell Technologies has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (90)
2024 (78)
2023 (56)
2022 (96)
2021 (33)
Funding
Current Stage
Late StageTotal Funding
$1M2023-06-06Grant· $1M
Leadership Team
Paul N. Saleh
President and Chief Executive Officer
Gary Call
Chief Medical Officer
Recent News
bloomberglaw.com
2025-12-12
GlobeNewswire
2025-12-11
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