Senior Medicaid Business Analyst (Configuration & Policy)

Gainwell Technologies LLC; Ohio; Remote; USD 69,000 - 99,000; Full time

Benefits offered by this job

Vacation policy

401(k)

Health benefits

Educational assistance

Job summary

Gainwell Technologies is seeking a Senior Medicaid Business Analyst (Configuration & Policy) to translate state and federal Medicaid policy into product features and system configuration. The role acts as a domain SME, ensuring CMS guidance alignment and successful implementation.

Responsibilities include building design docs, validating configurations, and supporting SIT/UAT. Remote work options are available from most US locations, with a strong focus on policy interpretation and healthcare

Qualifications

• Experience translating policy and program rules into system requirements, configuration support, and design artifacts.
• Strong knowledge of state and federal Medicaid policy, regulations, and program rules (required).
• Demonstrated experience translating policy into configuration and design documents.
• Experience with healthcare IT implementations and Medicaid MMIS projects.

Responsibilities

• Translate state and federal Medicaid policy and program requirements into product features, system configuration, and design artifacts.
• Serve as the domain SME to advise on business processes and regulatory impacts.
• Validate solution design and configuration against CMS guidance and policy.
• Provide domain SME support during SIT/UAT and defect analysis, root-cause investigations, and readiness validation.
• Develop and maintain domain design documentation, including workflows, interfaces, X12 EDI transactions, letters, and reports.
• Support domain-specific configuration within Design, Development, and Implementation (DDI) projects.

Skills

SQL

Policy knowledge

SDLC

Agile

Stakeholder comms

Education

Bachelor’s degree in Computer Science, Information Systems, Health Informatics, or a related field

Tools

QNXT

Job description

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. The Senior Medicaid Business Analyst (Configuration & Policy) at Gainwell, supports 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.

Acts as the primary Domain SME , serving as a trusted advisor to the Engagement Lead (EL) on business processes and associated regulatory and operational impacts.

Ensures compliance alignment by validating that solution design and configuration conform to CMS guidance, state policy, and documented business rules .

Supports the EL with in‑scope negotiations and change control , providing domain expertise to assess scope trade‑offs and the functional, regulatory, and operational impacts of change requests.

Interpret state and federal Medicaid policy, regulations, and program rules and translate them into product features, system configuration, business rules, and design artifacts.

Serve as a policy and domain SME , supporting the Domain Lead with analysis, interpretation, and solution recommendations.

Develop and maintain domain design documentation, with the Design Document as a core deliverable , covering workflows, interfaces, X12 EDI transactions, letters, and reports.

Document and communicate domain‑level decisions, risks, assumptions, and dependencies, assessing downstream impacts.

Build / Configuration

Support domain‑specific configuration and implementation activities within Design, Development, and Implementation (DDI) projects.

Responsible for configuration and partner with technical teams to ensure solutions align with approved design documentation, Medicaid policy interpretation, and documented business rules

Key configurations include but not limited to:

• Claims: Provider types, specialties, contracts, enrollment, credentialing
• Pharmacy: RX benefits, RX claims processing

Review test cases to ensure alignment with requirements, policy interpretation, and acceptance criteria.

Provide domain SME support during System Integration Testing (SIT) and User Acceptance Testing (UAT).

Support defect analysis, root‑cause investigation, resolution, retesting, and functional readiness validation.

Operational Readiness & Deployment

Support operational readiness activities, including environment, data, process, and staffing readiness.

Provide domain and policy input for Operational Readiness Reviews (ORR), parallel testing, and performance testing.

Support cutover preparation, transition to operations, and hypercare activities.

Work closely with the Domain Lead and Technical Analysts , acting as a trusted domain and policy SME.

Facilitate and participate in collaborative working sessions with business stakeholders, configuration teams, and technical teams.

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 similar healthcare provider/claims 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.
• ~ 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

Fully remote options from most US locations and territories

• ~ Video cameras must be used during all interviews, as well as during the initial week of orientation
• ~ Video is required for screenings and interviews, so please test your camera and microphone in advance.
• Do not use AI tools, virtual backgrounds/filters, or visual enhancements during the interview.

The pay range for this position is $69,400 - $99,200 per year, however, the base pay offered may vary depending on geographic region, internal equity, job‑related knowledge, skills, and experience among other factors. All salaried, full‑time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.