Medicaid Business Analyst

Appworkshub; United States; Remote; USD 110,000 - 140,000; Full time

Job summary

Appworkshub is seeking a Senior Medicaid Business Analyst to lead process analysis within Medicaid operations. You will analyze claims processing, eligibility, and provider workflows, and translate requirements into functional specifications for MMIS systems.

The role is 100% remote in the United States, long-term contract, requiring 7+ years in Medicaid, strong analytical skills, and collaboration with state programs and cross-functional teams to ensure compliance and efficient operations.

Qualifications

• 7+ years as a Business Analyst in Medicaid or Healthcare domain.
• Strong knowledge of MMIS modules (Claims, Eligibility, Provider, Member, Finance, etc.).
• Experience with Medicaid Claims Processing workflows.
• Strong analytical and problem-solving skills.
• Excellent communication and documentation abilities.
• Experience working with cross-functional teams and state-level Medicaid programs.

Responsibilities

• Analyze Medicaid/Healthcare business processes and provide recommendations for improvements
• Work with stakeholders to gather, document, and validate business and technical requirements
• Support MMIS functional enhancements and integrations
• Perform gap analysis, impact assessments, and workflow documentation
• Collaborate with technical teams to translate requirements into functional specifications
• Support testing activities including UAT, test case creation, and validation
• Ensure compliance with Medicaid regulations, CMS guidelines, and state policies
• Prepare reports, presentations, and process documentation as needed

Skills

7+ years as a Business Analyst in…

MMIS modules knowledge

Medicaid Claims Processing workflows

Analytical problem-solving

Communication and documentation

Cross-functional & state Medicaid

Job description

Job Title: Senior Medicaid Business Analyst
Location: 100% Remote
Duration: Long Term Contract
Job Description:
We are seeking a highly skilled Senior Medicaid Business Analyst with strong experience in Healthcare, Medicaid programs, and MMIS. The ideal candidate will support business process analysis, requirements gathering, documentation, and system enhancements within Medicaid operations. This role requires excellent understanding of Medicaid claims processing, provider management, member eligibility, and regulatory compliance.

Responsibilities

• Analyze Medicaid/Healthcare business processes and provide recommendations for improvements
• Work with stakeholders to gather, document, and validate business and technical requirements
• Support MMIS functional enhancements and integrations
• Perform gap analysis, impact assessments, and workflow documentation
• Collaborate with technical teams to translate requirements into functional specifications
• Support testing activities including UAT, test case creation, and validation
• Ensure compliance with Medicaid regulations, CMS guidelines, and state policies
• Prepare reports, presentations, and process documentation as needed

Required Skills

• 7+ years as a Business Analyst in Medicaid or Healthcare domain
• Strong knowledge of MMIS modules (Claims, Eligibility, Provider, Member, Finance, etc.)
• Experience with Medicaid Claims Processing workflows
• Strong analytical and problem-solving skills
• Excellent communication and documentation abilities
• Experience working with cross-functional teams and state-level Medicaid programs