Senior Business Analyst - Medicaid

Summary

As a Senior Business Analyst - Medicaid 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.

The Business Analyst will serve as the liaison between business stakeholders, technical teams, and external partners to gather, analyze, and document requirements for the Medicaid Management Information System (MMIS) and related healthcare applications. This role will focus on ensuring that system enhancements, configurations, and implementations align with Medicaid program rules, federal and state regulations, and operational needs.

Here are the details on this position.

Your role in our mission

Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas.

Requirements Gathering & Analysis

• Elicit and document business requirements from stakeholders, system users, and operation teams.
• Analyze current MMIS processes, workflows, and data structures to identify gaps, inefficiencies, and improvement opportunities.
• Translate business needs into functional and non-functional requirements, ensuring traceability from inception to delivery.

System & Process Documentation

• Develop detailed Business Requirements Documents (BRDs), Functional Specifications, and Use Cases for system changes and enhancements.
• Document data mapping, processing rules, and integration points with other healthcare systems (e.g., Home Based Services, Eligibility Systems, Third-Party Services).
• Maintain comprehensive process flow diagrams and operational guides.

.... your role continued

Collaboration & Communication

• Work closely with developers, QA testers, and system architects to ensure requirements are clearly understood and implemented correctly.
• Coordinate with state Medicaid stakeholders, and vendors to ensure compliance with CMS and HIPAA regulations.
• Participate in daily stand-ups, backlog grooming, sprint planning, and user acceptance testing (UAT) sessions.

Testing & Validation

• Develop and execute test cases for system changes and enhancements, ensuring functionality meets documented requirements.
• Support UAT by assisting end users with scenario testing and defect triage.
• Validate data integrity across MMIS modules and external interfaces, especially in care management, home care based services, claims processing, provider management, and member eligibility.

Change Management & Training

• Assist with impact analysis for system changes and new implementations.
• Provide training materials and knowledge transfer sessions for users and stakeholders.
• Support the creation of operational readiness documentation for new releases.

What we're looking for

• Bachelor’s degree in Business Administration, Information Systems, Healthcare Administration, or related field (or equivalent experience).
• Knowledge of identity management security systems (e.g., Ping Identity, Okta, Forgerock).
• Knowledge of Medicaid regulations, CMS guidelines, and HIPAA compliance.
• Proficient in creating process flow diagrams, data mapping documents, and requirements specifications.
• Experience with tools such as ALM, JIRA, Confluence, MS Visio, and SQL (for data validation).
• Excellent communication, analytical thinking, and problem-solving skills.

Preferred Qualifications

• 5+ years as a Business Analyst, preferably in Medicaid, healthcare, or public sector IT systems.
• Experience with federal or state healthcare system modernization projects.
• Knowledge of Agile/Scrum and Waterfall methodologies.
• Familiarity with system integrations using web services (SOAP/REST) and message queues.
• Strong understanding of MMIS modules, especially claims processing, provider enrollment, member eligibility, and home care based services.

What you should expect in this role

• Remote work from continental US locations only.
  Denver area candidates, hybrid options might be required.
• Travel up to 10% for on-site meetings for critical security deployments.
• May require extended hours during critical deployments or production issues.
• Video cameras must be used during all interviews, as well as during the initial week of orientation
• The deadline to submit applications for this posting is August 27, 2025.