Business Analyst (MMIS)

Conduent is a company that delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments. They are seeking a Business Analyst to serve in CMdS product development and implementation on a Medicaid modernization program, focusing on translating legacy MMIS claims, member, and finance behavior into functional design and requirements.

Responsibilities:

• Own requirements and functional design for assigned CMdS modules (Claims, Member, Finance, and related interfaces)
• Define epics, user stories, and definition of done; prioritize against Medicaid policy, MES certification goals, and release plans
• Facilitate working sessions; clarify requirements for developers and QA; resolve functional questions during build and test
• Track scope, dependencies, risks, and decisions; maintain traceability from legacy rule to CMdS design to test evidence
• Lead functional design for claim intake, claim type assignment, validity/pricing edits, adjustment/void, crossover, encounters, remittance, and related edit disposition behavior; map legacy rules to CMdS configuration and customizations
• Lead design for eligibility spans, aid category / benefit package assignment, enrollment, MCO/FFS indicators, and interfaces from state eligibility systems into CMdS Member
• Lead design for payment cycles, budget account / category of service, fund splits, ASO / F/EA and other administrative payment paths, financial transactions, and reporting/accounting controls
• Produce BRDs, FRDs, process flows, data mapping, gap analysis, and configuration workbooks suitable for build and UAT
• Work side-by-side with developers on design walkthroughs, edge cases, and defect triage
• Partner with QA to define test scenarios, expected results, and regression packs (positive/negative, adj/void, crossover, encounter, finance posting)
• Support SIT, UAT, and parallel/run-compare activities against legacy MMIS outcomes
• Validate that implementations meet Medicaid policy and MES operational readiness (security, audit, reporting, interfaces)
• Run workshops with business owners, SMEs, fiscal, and operations
• Align designs to CMS MES expectations (modularity, interoperability, standards-based interfaces, certification evidence)
• Support change management: training outlines, release notes, and operational runbooks for CMdS go-live

Requirements:

• 6+ years business analysis experience in Medicaid MMIS / MES, with deep hands-on work in at least two of: Claims, Member/Eligibility-Enrollment, Finance/Financial Accounting
• Proven experience developing and implementing claims systems / MMIS / MES platforms, such as Conduent CMdS (Conduent Medicaid Suite), Health Enterprise, QNXT, Facets, or comparable commercial Medicaid/claims suites
• Experience modernizing or replacing legacy MMIS (COBOL/mainframe or equivalent) with a commercial Medicaid platform
• Strong Medicaid domain knowledge, including: FFS vs managed care; capitation vs ASO / administrative services models; Claim types, media sources, edits/EOBs, adjustments/voids, Medicare crossover, encounters; Aid categories, benefit packages, eligibility spans, timely filing, TPL concepts; Provider payments, remittance advice, budget/object codes, COS, fund source / FFP concepts; CMS / state Medicaid policy drivers relevant to MES implementation and certification
• Demonstrated ability to write clear functional design and acceptance criteria for complex adjudication and financial rules
• Experience working embedded with development and QA teams in Agile or hybrid SDLC
• Excellent facilitation, documentation, and stakeholder communication skills
• Hands-on CMdS configuration or implementation (Claims, Member, Finance, Reference, Service Auth)
• Familiarity with HIPAA X12 (837/835), COBA/crossover, EVV-related claim flows
• Experience supporting CMS MES certification artifacts and evidence packages
• Prior lead BA experience on multi-module MES releases