Business Analyst, MMIS

Conduent; Atlanta (GA); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Dental and vision insurance

Life insurance

Retirement plan

Paid holidays

Paid time off

Job summary

Conduent seeks a seasoned Business Analyst to drive CMdS module design (Claims, Member, Finance) on a Medicaid modernization program in Atlanta. You will translate legacy MMIS rules into CMdS configurations and work closely with development, QA, and operations to ensure MES readiness.

The role requires strong Medicaid policy knowledge, expertise in CMdS or similar platforms, and proven facilitation and documentation skills to deliver compliant, testable designs.

Qualifications

• 6+ years business analysis experience in Medicaid MMIS/MES
• Experience developing and implementing claims systems/MMIS/MES platforms such as CMdS, Health Enterprise, QNXT, Facets
• Experience modernizing legacy MMIS (COBOL/mainframe) with a commercial platform
• Strong Medicaid policy knowledge and MES certification familiarity
• Ability to write clear functional design and acceptance criteria for complex rules
• Experience working with development and QA teams in Agile or hybrid SDLC

Responsibilities

• Own requirements and functional design for CMdS modules (Claims, Member, Finance)
• Define epics, user stories, and definitions of done; prioritize per Medicaid policy and MES goals
• Facilitate workshops; clarify requirements for developers and QA
• Maintain traceability from legacy rules to CMdS design and test evidence
• Lead functional design for Claims, Member, Finance areas and map legacy rules to CMdS configurations
• Produce BRDs, FRDs, process flows, data mapping, and gap analyses for build/UAT
• Collaborate with Development & QA to review designs and support testing
• Support SIT, UAT, and parallel/run-compare activities against legacy MMIS

Skills

Business analysis

Medicaid domain knowledge

Agile/Hybrid SDLC

Stakeholder facilitation

Requirements management

Education

Bachelor's degree in business, information systems, health informatics, or related field

Tools

CMdS configuration

QNXT

Facets

Job description

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.

Business Analyst — CMdS Claims, Member & Finance Implementation (MES)

Experience: 6+ years

Domain: Medicaid Enterprise Systems (MES) | MMIS modernization | Claims / Member / Finance

Role summary

Serve as Business Analyst for CMdS product development and implementation on a Medicaid modernization program. Translate legacy MMIS claims, member, and finance behavior and state Medicaid policy into CMdS functional design, requirements, and acceptance criteria. Partner with development, QA, architecture, and business stakeholders to deliver MES-aligned solutions that replace or integrate with legacy adjudication, eligibility/enrollment, and financial accounting processes.

Key responsibilities

Delivery & analysis

• 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.

Functional design (Claims, Member, Finance)

• Claims: 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.
• Member: Lead design for eligibility spans, aid category / benefit package assignment, enrollment, MCO/FFS indicators, and interfaces from state eligibility systems into CMdS Member.
• Finance: 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.

Collaboration with Development & QA

• 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).

Stakeholder & MES engagement

• 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.

Required qualifications

• 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.

Preferred qualifications

• 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.

Soft skills

• Comfortable owning ambiguity when legacy rules are incomplete; drives decisions with SMEs.
• Balances policy accuracy with delivery timelines.
• Credible with technical teams and business executives alike.

Education

Bachelor’s degree in business, Information Systems, Health Informatics, or related field (or equivalent experience).

Pay Transparency Laws in some locations require disclosure of compensation and/or benefits-related information. For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and/or sick time. The estimated salary range for this role is $70,000 - $90,000.

Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.