Senior Business Analyst - Medicaid

Gainwell Technologies LLC

38d•$69,400 - $99,200•Remote

About The Position

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities. SummaryAs 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

Six or more years of business analysis experience in Healthcare industry.
Bachelor’s degree in business administration, information systems, healthcare administration, or related field preferred. or equivalent combination of education and experience.
Experience in healthcare claims processing (institutional and professional), benefit plan rules, and adjudication logic required.
Experience with Medicaid Management Information Systems (MMIS) or similar healthcare platforms strongly preferred.
To a lesser extent, experience with dental claims processing is also desirable.
Experience working with the interface of information technology and functional groups within an organization.
Experience with business processes and re-engineering.
Familiarity with computer programming concepts and basic language.
Strong interpersonal skills to interact with customers and team members.
Excellent communication and analytical skills.
Ability to present findings and recommendations to management and clients.
Proficiency with personal computer and business solutions software.
Ability to work collaboratively in a team environment.
Willingness to travel as needed.

Responsibilities

Plans, designs, and recommends business processes to improve and support healthcare-related business activities.
Analyzes and documents client business requirements and processes, with a focus on claims processing workflows (institutional and professional), benefit plan rules, and adjudication logic.
Communicates requirements by constructing conceptual data and process models, including data dictionaries and volume estimates.
Creates test scenarios and develops test plans to validate healthcare claims processing functionality, ensuring compliance with Medicaid and other payer requirements.
Provides input into developing and modifying systems to meet client needs, including MMIS or similar healthcare platforms.
Facilitates meetings with clients to gather and document requirements and explore potential solutions for claims processing and benefit plan administration.
Assists in coordinating business analyst tasks on healthcare IT projects and provides support to other team members.
Participates in technical reviews and inspections to verify that changes align with business intent and regulatory compliance.
Assists in providing time estimates for project-related tasks.
Develops methods and procedures to ensure current business goals and objectives meet organizational and regulatory needs.