Supporting business, policy, and technical execution across functional domains within MMIS Medicaid Management Information Systems (MMIS) and/or the Medicaid Pharmacy environment.
Ensuring solutions align with CMS guidance, state policy, and documented business rules.
Leading and participating in requirements and design sessions with clients and internal teams to validate functional and technical needs.
Interpreting federal and state Medicaid policies and translating them into system configuration, product features, business rules, and design artifacts.
Developing and maintaining domain design documentation, including a comprehensive Design Document covering workflows, interfaces, X12 EDI transactions, letters, and reports.
Supporting operational readiness across environments, data, processes, and staffing.

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.

Senior Business Analyst – Provider

Key skills