Advisor Business Analyst - Bureau of Quality & Oversight

Summary

As an Advisor Business Analyst - Bureau of Quality & Oversight 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.

Under the direction of the Section Manager for Program Participation Oversight (PPO), this position is responsible for administering and enhancing the adult LTC provider enrollment system.

The position serves as BQO’s (Bureau of Quality & Oversight) technical lead for provider enrollment data, system functionality, system changes, and data analytics. 

Your role in our mission

• Lead development, maintenance, and enhancement activities for the adult LTC provider enrollment system based on policy, regulatory, and contractual changes. 

• Review, analyze, and interpret statutes, regulations, and policies to develop system requirements and technical specifications. 

• Coordinate system design, testing, implementation, and validation with internal teams and contractors. 

• Serve as the technical subject‑matter expert on adult provider enrollment, MCO Provider Network data, Medicaid Provider Extracts, and related interfaces. 

• Investigate and resolve system, interface, and data integrity issues. 

• Develop SAS, MMIS, CARES, and related data queries; validate and interpret results; prepare data in formats usable for leadership and program staff. 

• Produce standard and ad‑hoc reports, charts, tables, analyses, and presentations. 

• Conduct data trend analysis and recommend improvements for system performance and data quality. 

• Provide technical guidance and consultation to internal staff, leadership, vendors, and external stakeholders. 

• Ensure data handling and releases comply with HIPAA requirements. 

• Support special projects, vendor demonstrations, research activities, and adoption of new data tools. 

What we're looking for

Healthcare & Medicaid Domain Expertise

• Nine or more years of  Business Analyst experience working in the Healthcare Industry. 3 or more years of Medicaid and Medicare experience preferred
• Extensive knowledge of Medicaid and other healthcare data reporting
• Knowledge of the State of Wisconsin adult long-term care programs
• Strong understanding of Medicaid MMIS, CARES, and related healthcare IT systems
• Extensive knowledge of HIPAA regulations and healthcare data/transaction standards or commensurate experience in healthcare information technology

Communication, Collaboration & Problem-Solving Skills

• Advanced oral and written communication skills, including the ability to create and deliver clear presentations
• Strong facilitation skills, including conducting meetings and working with diverse stakeholders
• Ability to work independently and collaboratively in a team environment
• Skill in solving complex problems involving multiple perspectives
• Demonstrated ability to collaborate with public and private agencies and service delivery systems
• Experience working in a complex, matrixed work environment

What you should expect in this role

• Fully remote options from continental US locations only
• Candidates local to Madison, WI have the option for hybrid
• Video cameras must be used during all interviews, as well as during the initial week of orientation
• This posting is intended for pipelining for a potential future position.
  This is a developing position therefore the job description is subject to change.

#LI-HC1

#LI-Wisconsin State programs

#LI-SAS

#LI-Managed Care Organization

#LI-Tableau

#LI-Long-term Care