Senior Business Analyst - Provider+

Gainwell Technologies

Deskripsi Pekerjaan

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities. Summary As a Senior 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. Will be supporting 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. This role 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 mission Requirements & Design 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. Build / Configuration 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 Testing 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. Operational Readiness & Deployment Supports operationa

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