Business Analyst

EEO:- Mindlance•Quincy, MA

1d•Hybrid

About The Position

The Massachusetts Executive Office of Health and Human Services (EOHHS) is seeking a Business Analyst with prior authorization expertise to join its Medicaid Management Information System (MMIS) team. The role supports established Provider Reimbursement and Claims Processing functional areas and the development, testing, and implementation of projects and enhancements serving the MassHealth program and its member community. The analyst must understand healthcare business systems, health plan operations, the systems development lifecycle, and Claims Processing, including prior authorizations, clients, and referrals. The role’s primary purpose is to ensure implemented coding meets business requirements and complies with applicable federal and state laws. The Business Analyst participates throughout project phases, including gap analysis, requirements gathering, design and development, documentation, testing, implementation, and stabilization. The position requires effective communication and documentation, and the ability to work independently, on a team, and with business stakeholders. The primary work location is 1 Enterprise Drive, Quincy, Massachusetts 02171. The schedule is Monday through Friday, 9:00 a.m. to 5:00 p.m., under a hybrid model combining in-office and work-from-home days as needed. Schedules may change based on business operational needs.

Requirements

Bachelor’s degree or higher in Business, IT, or Healthcare Administration, with at least 3 years of experience, or equivalent experience in a healthcare administration setting.
Knowledge of the scope of healthcare business systems and Claims Processing, including prior authorizations, clients, and referrals.
Excellent communication and documentation skills.
Ability to work independently, as part of a team, and with business stakeholders.

Nice To Haves

Medicaid systems experience and claims and business knowledge of the MassHealth program.
Knowledge of interoperability and emerging X.12 standards.
Knowledge of SDLC and Agile methodology.
Proficiency in business analysis supporting all stages of the system project lifecycle.
Competency in HIPAA claims and payment transaction processing.
Strong data analysis skills and SQL proficiency.
Excellent interpersonal skills to interact effectively with project managers, developers, business analysts, systems analysts, SQA analysts, business users and stakeholders, data processing personnel, and representatives of external agencies and companies.
Demonstrated ability to provide relevant system analysis services independently and within project teams.
Highly analytical approach, with the ability to independently analyze, document findings, and recommend solutions.

Responsibilities

Lead and participate in joint application design sessions with stakeholders.
Develop test strategies, scenarios, and cases based on written requirements.
Execute and review test runs and sign off on testing components.
Document requirements and participate in their development and testing.
Support development of end-user training materials and documentation as required.
Potentially oversee release stabilization, including monitoring system change execution, developing system fix strategies, and monitoring implementation of those strategies.
Work with vendors to ensure business requirements are fully defined and tested.
Communicate updates and changes to affected stakeholders.
Represent MMIS in business meetings as needed.
Support program staff, vendors, and other stakeholders with MMIS-related questions or concerns.
Provide backup to other business analysts as needed.
Perform data queries and analysis.