Senior Business Analyst – MMIS Claims Processing

S2Tech is a fast-growing IT consulting company known for its performance and innovation. They are seeking an experienced Senior Business Analyst to support a MMIS Claims Processing modernization program, focusing on business analysis, stakeholder facilitation, and requirements leadership.

Responsibilities:

• Lead requirements gathering, analysis, documentation, and validation activities for MMIS modernization initiatives with a primary focus on Claims Processing
• Facilitate Joint Application Design (JAD) sessions and working sessions with state stakeholders, business teams, technical teams, and vendors
• Translate complex business needs into clear, structured, and testable business requirements using established business analysis methodologies
• Track requirements from initial scope definition through refinement, validation, implementation, and testing support
• Conduct current-state versus future-state gap analysis and recommend modernization approaches aligned with Commonwealth objectives
• Ensure requirements traceability throughout the Software Development Life Cycle (SDLC)
• Support defect triage, operational impact analysis, issue resolution, and change management activities
• Partner closely with development and QA teams to ensure business intent is accurately implemented
• Lead analysis activities supporting modernization of the MMIS Claims Processing solution, including: Claims intake and submission workflows, Claims editing and validation, Claims adjudication and pricing, Payment processing and financial disposition, Denials, suspensions, adjustments, and voids, Coordination of Benefits (COB), Third Party Liability (TPL), Managed Care encounter processing, Provider reimbursement methodologies, Claims lifecycle reporting and operational monitoring
• Analyze and document business requirements supporting multiple claim submission channels, including: Provider Web Portal, Electronic Data Interchange (EDI), X12 transaction processing, Batch file interfaces, Clearinghouse integrations, System-to-system interfaces
• Develop business requirements supporting the processing of standard healthcare transactions, including: 837 Institutional (837I), 837 Professional (837P), 837 Dental (837D), 835 Electronic Remittance Advice, 270/271 Eligibility Inquiry & Response, 276/277 Claim Status Inquiry & Response, Other HIPAA-compliant X12 transactions supporting Medicaid operations
• Collaborate with business and technical teams to analyze: Claims editing rules, Benefit and policy validation, Payment logic, Pricing methodologies, Provider reimbursement, Financial reconciliation, Exception handling, Operational workflows
• Support analysis of claims interfaces with related MMIS modules, including: Provider Management, Member Eligibility, Prior Authorization, Third Party Liability, Reference Data, Financial Management, Pharmacy, Data Warehouse and Reporting, Documentation & Deliverables
• Produce comprehensive Business Requirements Documents (BRDs) including: Business background and objectives, Current-state and future-state business processes, Claims workflow analysis, Business rules, Detailed business requirements, Operational impacts and dependencies, Assumptions, Key decisions, Open issues, Testing considerations, Validation scenarios
• Develop: Process flows, Decision trees, Use cases, Decision tables, Data mapping documentation, Interface specifications, Business rules catalogs, Workflow diagrams
• Maintain high-quality documentation standards across all deliverables
• Leverage AI tools and prompt engineering techniques to support requirements generation, business analysis activities, and documentation development
• Create and refine AI prompts to improve the quality and efficiency of requirements-related deliverables
• Evaluate AI-generated output for accuracy, completeness, consistency, and business relevance
• Apply critical thinking and business judgment when utilizing AI-assisted analysis techniques
• Build strong working relationships with client stakeholders, project leadership, and cross-functional teams
• Facilitate productive discussions and diplomatically challenge unclear or incomplete requirements when necessary
• Communicate complex business and technical concepts effectively to both technical and non-technical audiences
• Anticipate downstream impacts, risks, dependencies, financial implications, and operational considerations associated with requirements decisions
• Operate independently as a self-starter while contributing to broader modernization program objectives

Requirements:

• Strong experience as a Business Analyst supporting MMIS/MES or Medicaid modernization initiatives
• Direct experience supporting MMIS Claims Processing
• Strong understanding of the complete Medicaid claims lifecycle from submission through adjudication, payment, adjustment, and financial reconciliation
• Experience with claims editing, pricing, adjudication logic, payment methodologies, and business rules
• Experience working with HIPAA X12 healthcare transaction standards
• Experience supporting electronic claims processing and multiple claim intake channels
• Strong preference for candidates with CLIENT-SIDE MMIS experience (state agency/business operations perspective) versus solely vendor-module implementation experience
• Demonstrated experience facilitating stakeholder sessions, JAD workshops, and executive-level business discussions
• Proven experience producing high-quality BUSINESS requirements (not solely functional or technical requirements)
• Deep understanding of: Requirements gathering and validation, Business process analysis, SDLC methodologies, Gap analysis, Medicaid claims operations, Claims adjudication business rules, Healthcare payment processing, Medicaid policy-driven systems
• Strong verbal and written communication skills with close attention to detail
• Ability to manage ambiguity and operate effectively within large-scale enterprise modernization efforts
• CBAP certification or strong BABOK familiarity preferred
• Experience supporting large-scale state Medicaid modernization initiatives
• Experience with AI-assisted business analysis or prompt engineering concepts
• Experience with multiple MMIS functional modules including: Provider Management, Member Eligibility, Prior Authorization, Financial Management, Pharmacy, Data Warehouse/Reporting
• Familiarity with CMS Medicaid Information Technology Architecture (MITA) principles