Summary

As a Senior Business Analyst - Provider+ 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.

Will be supporting business, policy, and technical execution across one or more functional domains within MMIS Medicaid Management Information Systems (MMIS) and/or the Medicaid Pharmacy environment. Supported domains may include Member, Provider, Claims (Medicaid, Dental and/or Pharmacy), Finance, Plan and Care Management, and Business Relationship Management.

This role supports end‑to‑end domain delivery by translating state and federal Medicaid policy and program requirements into product features, system configuration, and design artifacts. The Business Analyst works closely with the Domain Lead, Technical Analysts, and cross‑functional teams and acts as a domain and policy subject‑matter expert (SME) to ensure successful implementation and operational readiness.

Your role in our mission

Requirements & Design
Serves as the primary Domain SME and trusted advisor to the Engagement Lead (EL) on business processes, including regulatory and operational impacts. Ensures solutions align with CMS guidance, state policy, and documented business rules. Supports the EL with scope negotiations and change control by assessing trade‑offs and evaluating functional, regulatory, and operational impacts of requested changes.

Leads and participates in requirements and design sessions with clients and internal teams to validate functional and technical needs. Interprets federal and state Medicaid policies and translates them into system configuration, product features, business rules, and design artifacts. Acts as a policy SME supporting the Domain Lead with analysis, interpretation, and solution recommendations.

Develops and maintains domain design documentation, including a comprehensive Design Document covering workflows, interfaces, X12 EDI transactions, letters, and reports. Ensures requirements are accurate, complete, and traceable, with clearly defined acceptance criteria. Documents domain-level decisions, assumptions, risks, and dependencies, evaluating downstream impacts.

Build / Configuration
Supports configuration and implementation activities across Design, Development, and Implementation (DDI). Partners with technical teams to ensure solutions align with approved designs, policy interpretations, and business rules. Responsible for domain-specific configuration, including:

• Claims: edits, pricing, benefit limits, adjudication logic
• Plan: contracts, benefits, programs, fee schedules
• Provider: types, specialties, contracts, enrollment, credentialing
• Member: eligibility, benefits, plans, demographics
• Pharmacy: RX benefits and claims processing

Testing
Reviews test cases to ensure alignment with requirements, policies, and acceptance criteria. Provides SME support during System Integration Testing (SIT) and User Acceptance Testing (UAT). Assists with defect analysis, root cause investigation, resolution validation, retesting, and ensuring overall functional readiness.

Operational Readiness & Deployment
Supports operational readiness across environments, data, processes, and staffing. Provides domain expertise for Operational Readiness Reviews (ORR), parallel testing, and performance testing. Contributes to cutover planning, transition to operations, and hypercare support.

Collaboration & Client Engagement
Partners closely with Domain Leads and Technical Analysts as a key domain and policy SME. Leads and supports client communications, including requirements discussions, design reviews, and issue resolution. Facilitates working sessions across business, configuration, and technical teams. Delivers functional demos and solution walkthroughs to validate product alignment with client needs. Supports documentation, knowledge transfer, and ongoing operational support.

What we're looking for

• Bachelor’s degree in Computer Science, Information Systems, Health Informatics, or a related field.
• 5 to 8 years of hands‑on experience supporting healthcare system implementations, including MMIS solutions and Medicaid Pharmacy platforms.
• Experience with QNXT or similar healthcare claims/encounter management systems.
• Strong knowledge of state and federal Medicaid policy, regulations, and program rules (required).
• Strong understanding of Medicaid domains, including claims, member, provider, and prior authorization processes.
• Demonstrated experience translating policy and program rules into system requirements, configuration support, and design artifacts.
• Strong knowledge of SQL is required, particularly for data analysis and validation.
• Strong client communication skills, with experience interacting directly with business stakeholders.
• Proven ability to lead or support functional demonstrations, walkthroughs, and collaborative working sessions.
• Strong documentation, facilitation, and analytical skills.
• Experience working in SDLC and Agile delivery environments.

What sets you apart

What you should expect in this role

• Fully remote options from Contiguous US locations only

• Video cameras must be used during all interviews, as well as during the initial week of orientation

• The deadline to submit applications for this posting has been extended until a suitable candidate is selected.