Senior Business Analyst - Medicaid

Gainwell Technologies LLC

43d•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

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.