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Experienced Provider+ Business Analyst - MMIS / Medicaid Pharmacy

Date:  Jun 20, 2026
Location: 

Any city, DC, US, 99999

Req ID:  35734
Work Mode:  Virtual (Exception only)

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. 

 

Summary

As an Experienced Provider+ Business Analyst - MMIS / Medicaid Pharmacy 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.

 

The Experienced Provider+ Business Analyst supports business, policy, and technical execution across one or more functional domains within MMIS Medicaid Management Information Systems (MMIS) and/or the Medicaid Pharmacy environment. Supported domains may include Member, Provider, Claims (Medicaid, Dental and/or Pharmacy), Finance, Plan and Care Management, and Business Relationship Management.

This role supports end‑to‑end domain delivery by translating state and federal Medicaid policy and program requirements into product features, system configuration, and design artifacts. The Business Analyst works closely with the Domain Lead, Technical Analysts, and cross‑functional teams and acts as a domain and policy subject‑matter expert (SME) to ensure successful implementation and operational readiness.

Your role in our mission

 

Requirements & Design
Acts as the primary Domain Subject Matter Expert (SME) and trusted advisor to the Engagement Lead (EL), providing guidance on business processes and regulatory/operational impacts. Ensures solution design and configuration align with CMS guidance, state policy, and documented business rules. Supports in-scope negotiations and change control by evaluating scope trade-offs and associated functional, regulatory, and operational impacts.

Leads and participates in requirements and design sessions with clients and internal teams to validate business and technical needs. Interprets federal and state Medicaid policy, translating it into product features, system configurations, business rules, and design artifacts. Serves as a domain SME, supporting analysis, interpretation, and solution recommendations.

Develops and maintains domain design documentation (including Design Documents) covering workflows, interfaces, X12 EDI transactions, letters, and reports. Ensures requirements and acceptance criteria are accurate, complete, and traceable. Documents and communicates decisions, risks, assumptions, and dependencies, including downstream impacts.

Build / Configuration
Supports configuration and implementation activities across Design, Development, and Implementation (DDI). Partners with technical teams to ensure alignment with approved designs, policy interpretation, and business rules. Configures key functional areas including:

  • Claims: edits, pricing, benefit limits, adjudication logic
  • Plan: contracts, benefits, programs, fee schedules
  • Provider: provider types, specialties, enrollment, credentialing
  • Member: eligibility, demographics, benefit plans
  • Pharmacy: RX benefits and claims processing

Testing
Reviews test cases for alignment with requirements and policy. Provides SME support during System Integration Testing (SIT) and User Acceptance Testing (UAT). Assists with defect analysis, root cause investigation, resolution, retesting, and validation of functional readiness.

Operational Readiness & Deployment
Supports operational readiness across environments, data, processes, and staffing. Contributes domain expertise to Operational Readiness Reviews (ORR), parallel testing, and performance testing. Assists with cutover planning, transition to operations, and hypercare support.

Collaboration & Client Engagement
Partners closely with Domain Leads, technical teams, and stakeholders as a trusted SME. Leads and supports client interactions, including requirements discussions, design reviews, and issue resolution. Plans and delivers demos and walkthroughs to validate solutions against requirements. Facilitates working sessions across business, configuration, and technical teams, and supports documentation, knowledge transfer, and ongoing operations.

What we're looking for

  • Bachelor’s degree in Computer Science, Information Systems, Health Informatics, or a related field.
  • 5 to 8 years of hands‑on experience supporting healthcare system implementations, including MMIS solutions and Medicaid Pharmacy platforms.
  • Experience with QNXT or similar healthcare claims/encounter management systems.
  • Strong knowledge of state and federal Medicaid policy, regulations, and program rules (required).
  • Strong understanding of Medicaid domains, including claims, member, provider, and prior authorization processes.
  • Demonstrated experience translating policy and program rules into system requirements, configuration support, and design artifacts.
  • Strong knowledge of SQL is required, particularly for data analysis and validation.
  • Strong client communication skills, with experience interacting directly with business stakeholders.
  • Proven ability to lead or support functional demonstrations, walkthroughs, and collaborative working sessions.
  • Strong documentation, facilitation, and analytical skills.
  • Experience working in SDLC and Agile delivery environments.

What Sets You Apart

  • Knowledge of MITA (Medicaid Information Technology Architecture).
  • Experience with system integrations, EDI/X12 transactions, analytics, and reporting.
  • Familiarity with state and federal healthcare regulations and compliance standards.

What you should expect in this role

  • Fully remote options from Contiguous US locations only
  • Video cameras must be used during all interviews, as well as during the initial week of orientation
  • This posting is intended for pipelining. This is a developing position therefore the job description is subject to change.

#LI-HC1

#LI-MMIS

#LI-Medicaid Pharmacy

 

The pay range for this position is $86,800 - $124,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

 

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

 

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

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