Job Description
- Analyze and interpret CMS, Medicaid, and state reporting requirements.
- Support T-MSIS, CMS-64, CMS-37, PERM, and other federal reporting initiatives.
- Ensure MMIS reporting processes comply with federal and state regulations.
- Monitor reporting changes and assess business and system impacts.
Key Responsibilities
Federal Reporting & Compliance
- Analyze and interpret CMS, Medicaid, and state reporting requirements.
- Support T-MSIS, CMS-64, CMS-37, PERM, and other federal reporting initiatives.
- Ensure MMIS reporting processes comply with federal and state regulations.
- Monitor reporting changes and assess business and system impacts.
Business Analysis
- Gather, document, and manage business and functional requirements.
- Create BRDs, Functional Specifications, User Stories, and Process Flows.
- Conduct gap analyses and impact assessments for regulatory changes.
- Establish traceability between requirements, testing, and implementation.
Data Analysis & Validation
- Perform data validation, reconciliation, and quality assurance activities.
- Analyze claims, provider, member, encounter, and financial data.
- Identify data anomalies and work with technical teams to resolve issues.
- Validate report accuracy prior to submission.
Stakeholder Management
- Serve as the primary liaison between State Medicaid agencies, business users, reporting teams, and IT.
- Facilitate requirements workshops, reviews, and stakeholder meetings.
- Present reporting findings, risks, and recommendations to leadership.
Testing & Implementation Support
- Develop and execute test scenarios for reporting enhancements.
- Support SIT, UAT, regression testing, and production validation.
- Review defects, perform root cause analysis, and validate fixes.
- Support release planning and deployment activities.
Operational Support
- Support monthly, quarterly, and annual federal reporting cycles.
- Assist with audit requests and compliance reviews.
- Create operational procedures, SOPs, and reporting documentation.
- Support production issue analysis and resolution.
Required Qualifications
- Bachelor's degree in Business, Healthcare Administration, Information Systems, or related field.
- 5+ years of Business Analyst experience.
- 3+ years of MMIS or Medicaid experience.
- Strong knowledge of Medicaid claims, providers, members, financials, and encounters.
- Experience with federal reporting programs such as T-MSIS, CMS-64, CMS-37, or PERM.
- Experience creating BRDs, Functional Requirements, User Stories, and test cases.
- Strong SQL and data analysis skills.
- Experience working in Agile and/or Waterfall environments.
Preferred Qualifications
- MMIS modernization or O&M experience.
- Knowledge of healthcare EDI transactions (837, 835, 270/271, etc.).
- Experience with Cognos, Power BI, Tableau, or reporting tools.
- Experience supporting CMS audits and certification activities.
- CBAP or PMI-PBA certification preferred.
Key Skills
- Federal Medicaid Reporting
- T-MSIS Reporting
- Regulatory Compliance
- Requirements Management
- Data Analysis & Reconciliation
- SQL
- Defect Management
- UAT/SIT Testing
- Stakeholder Communication
- Documentation & Reporting
- Root Cause Analysis
Success Measures
- Timely and accurate federal report submissions.
- Compliance with CMS and State reporting requirements.
- Improved data quality and reporting accuracy.
- Successful implementation of reporting enhancements.
- Positive stakeholder and client satisfaction.
Qualifications
Graduate
Range Of Year Experience-Min Year
7
Range Of Year Experience-Max Year
10