SummaryAs a
Senior or Advisor 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.
We have two upcoming roles that we are currently sourcing.These positions support 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.
These roles 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 missionRequirements & Design- Acts as the primary Domain Subject Matter Expert (SME) and trusted advisor to the Engagement Lead (EL), providing guidance on business processes and regulatory/operational impacts.
- Ensures solution design and configuration align with CMS guidance, state policy, and documented business rules.
- Supports in-scope negotiations and change control by evaluating scope trade-offs and associated functional, regulatory, and operational impacts.
- Leads and participates in requirements and design sessions with clients and internal teams to validate business and technical needs.
- Interprets federal and state Medicaid policy, translating it into product features, system configurations, business rules, and design artifacts.
- Serves as a domain SME, supporting analysis, interpretation, and solution recommendations.
- Develops and maintains domain design documentation (including Design Documents) covering workflows, interfaces, X12 EDI transactions, letters, and reports.
- Ensures requirements and acceptance criteria are accurate, complete, and traceable.
- Documents and communicates decisions, risks, assumptions, and dependencies, including downstream impacts.
Build / ConfigurationBuilds key areas including:
- Supports configuration and implementation activities across Design, Development, and Implementation (DDI).
- Partners with technical teams to ensure alignment with approved designs, policy interpretation, and business rules.
Configures key functional areas including:
- Claims: edits, pricing, benefit limits, adjudication logic
- Plan: contracts, benefits, programs, fee schedules
- Provider: provider types, specialties, enrollment, credentialing
- Member: eligibility, demographics, benefit plans
- Pharmacy: RX benefits and claims processing
Testing- Reviews test cases for alignment with requirements and policy.
- Provides SME support during System Integration Testing (SIT) and User Acceptance Testing (UAT).
- Assists with defect analysis, root cause investigation, resolution, retesting, and validation of functional readiness.
Operational Readiness & Deployment- Supports operational readiness across environments, data, processes, and staffing.
- Contributes domain expertise to Operational Readiness Reviews (ORR), parallel testing, and performance testing.
- Assists with cutover planning, transition to operations, and hypercare support.
Collaboration & Client Engagement- Partners closely with Domain Leads, technical teams, and stakeholders as a trusted SME.
- Leads and supports client interactions, including requirements discussions, design reviews, and issue resolution.
- Plans and delivers demos and walkthroughs to validate solutions against requirements.
- Facilitates working sessions across business, configuration, and technical teams, and supports documentation, knowledge transfer, and ongoing operations.
What we're looking for- 5 to 8 years of hands-on experience supporting healthcare system implementations, including MMIS solutions and Medicaid Pharmacy platforms.
- 9+ years of hands-on experience supporting healthcare system implementations, including MMIS solutions and Medicaid Pharmacy platforms.
Both require:- Bachelor's degree in Computer Science, Information Systems, Health Informatics, or a related field.
- 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- Knowledge of MITA (Medicaid Information Technology Architecture).
- Experience with system integrations, EDI/X12 transactions, analytics, and reporting.
- Familiarity with state and federal healthcare regulations and compliance standards.
What you should expect in this role- Fully remote options from most US locations and territories
- Video cameras must be used during all interviews, as well as during the initial week of orientation
- This posting is intended for pipelining. This is a developing position therefore the job description is subject to change.
- #LI-HC1
The pay range for the
Senior position is $69,400 - $99,200 per year. The pay range for the
Advisor position is $86,800 - $124,000, however, the base pay offered on both may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
