Advisor Technical Business Analyst - Medicaid FHIR Architecture & Interoperability

Gainwell Technologies LLC•Any city, OH

4d•Remote

About The Position

Gainwell Technologies is seeking a Technical Business Analyst with deep Medicaid experience and strong FHIR architecture expertise to support large‑scale Medicaid modernization and interoperability initiatives. This role sits at the intersection of state Medicaid policy, enterprise architecture, and modern data exchange standards and plays a key part in translating complex Medicaid data and workflows into scalable, FHIR‑based solutions. The ideal candidate has hands‑on experience with Provider+, FHIR architecture, profiling, and data translation, and can operate as a trusted advisor to architects, engineers, and state clients—ensuring interoperability solutions are compliant, sustainable, and aligned to CMS and Gainwell standards.

Requirements

Nine or more years of experience working as a business analyst or ‘requirements translator’ between technical and non-technical personnel
3 or more years of Medicaid and Medicare experience preferred
Knowledge of Microsoft Excel advanced features such as macros and/or relational database software
Ability to clearly and concisely translate technical requirements to a non-technical audience
Skills working with business processes and re-engineering
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
Strong systems thinking and architectural mindset
Able to balance policy, data, and technology considerations
Excellent written and verbal communication
High attention to detail and regulatory compliance
Comfortable influencing without authority across teams

Nice To Haves

Familiarity with Gainwell’s Provider+ Product data and system design
Experience supporting CMS interoperability initiatives (Patient Access API, Provider Directory API, PA API)
Familiarity with integration platforms and tools: Postman, Swagger/OpenAPI, Interface engines (Mirth, Rhapsody), Cloud‑based integration services
Experience working on Medicaid transformation or modular MMIS modernization projects
Agile or hybrid SDLC experience in large enterprise environments

Responsibilities

Serve as a FHIR‑focused technical business analyst supporting Gainwell’s Medicaid interoperability and data exchange solutions.
Translate state Medicaid business requirements, CMS mandates, and client‑specific policies into FHIR‑aligned technical requirements.
Support architecture decisions related to FHIR‑based integration patterns, including APIs, canonical data models, and transformation strategies.
Partner with solution architects to ensure interoperability designs are scalable, reusable, and consistent with Gainwell enterprise standards.
Serve as a technical translator between Medicaid business stakeholders, state agencies, and engineering teams.
Clearly explain FHIR architecture and interoperability concepts to non‑technical audiences.
Support governance reviews, standards compliance, and documentation required by state Medicaid programs and CMS.
Lead analysis and documentation for mapping Medicaid data to and from FHIR (R4), including MMIS data models ↔ FHIR, X12 (270/271, 834, 837, 835) ↔ FHIR, and HL7 v2 ↔ FHIR.
Define and maintain FHIR profiles, extensions, value sets, and implementation guidance appropriate for Medicaid use cases.
Support FHIR API design by reviewing resource structures, payloads, search parameters, and business rules.
Ensure FHIR implementations align with CMS Interoperability and Prior Authorization rules, Patient Access and Provider Directory API requirements, and Gainwell reusable integration assets and patterns.
Produce clear, detailed technical artifacts, including FHIR data mapping documents, API and integration use cases, sequence diagrams and process flows, and acceptance criteria and validation rules.
Actively collaborate with integration and platform engineers, enterprise and solution architects, and state Medicaid SMEs and external vendors.
Review and validate transformation logic, schemas, and API contracts.
Support SIT and UAT by validating data accuracy, business compliance, and end‑to‑end interoperability.