Senior Business Analyst - Medicaid

Gainwell Technologies

4d • Remote

About The Position

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. Here are the details on this position.

Requirements

• Bachelor's degree in Healthcare Administration, Business, or related field (Master's preferred).
• 5+ years of experience in healthcare claims analysis, with strong Medicare/Medicaid expertise.
• In-depth knowledge of CMS regulations, HIPAA compliance, and state-specific Medicaid requirements.
• Hands-on experience with claims adjudication systems (Facets, QNXT, or similar).
• Strong analytical and problem-solving skills with proficiency in SQL and data visualization tools (Power BI, Tableau).
• Excellent communication and stakeholder management skills.

Nice To Haves

• Experience in Agile methodology and healthcare IT projects.
• Familiarity with EDI transactions (837, 835) and ICD/CPT coding.
• Ability to lead cross-functional teams and manage multiple priorities.

Responsibilities

• Lead requirements elicitation sessions with business stakeholders and technical teams.
• Analyze and document current-state and future-state processes for Medicare and Medicaid claims.
• Serve as a subject matter expert (SME) on CMS guidelines, state Medicaid rules, and claims adjudication workflows.
• Develop detailed business and functional requirements for system enhancements and integrations.
• Partner with IT teams to design solutions and validate technical feasibility.
• Oversee User Acceptance Testing (UAT) and ensure quality deliverables.
• Monitor KPIs such as claim turnaround time, denial rates, and compliance adherence.
• Provide guidance and mentorship to junior analysts.
• Prepare executive-level reports and presentations on claims performance and regulatory compliance.

Benefits

• work flexibility
• learning
• career development
• generous, flexible vacation policy
• educational assistance
• 401(k) employer match
• comprehensive health benefits
• leadership and technical development academies

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees