Senior Business Analyst - Provider+

Gainwell Technologies is a company focused on improving the health and well-being of vulnerable communities through technology. As a Senior Business Analyst - Provider+, you will support business, policy, and technical execution within Medicaid Management Information Systems and collaborate with cross-functional teams to translate Medicaid policy into product features and system configurations.

Responsibilities:

• 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
• 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
• 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
• 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
• 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

Requirements:

• 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
• 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