Gainwell TechnologiesRemote
Senior Business Analyst - Medicaid
United States
Full-time
2 hours ago
$65,000 - $93,000 USD
H1B Sponsor Likely
Key skills
Medicare/Medicaid expertiseCMS regulations knowledgeClaims adjudication systemsSQL proficiencyData visualization toolsAnalytical skillsStakeholder managementAgile methodologyEDI transactions familiarityICD/CPT codingProblem-solving skillsCommunication skillsLeadership skillsCross-functional team managementSQLBITableauPower BIAgileStakeholder ManagementMentoringCommunication
About this role
Gainwell Technologies is dedicated to improving the health and well-being of vulnerable communities through innovative technology solutions. As a Senior Business Analyst - Medicaid, you will lead requirements elicitation, analyze healthcare claims processes, and collaborate with IT teams to design effective solutions while mentoring junior analysts.
Responsibilities:
- Lead requirements elicitation sessions with business stakeholders and technical teams
- Analyze and document current-state and future-state processes for Medicare and Medicaid claims
- Serve as a subject matter expert (SME) on CMS guidelines, state Medicaid rules, and claims adjudication workflows
- Develop detailed business and functional requirements for system enhancements and integrations
- Partner with IT teams to design solutions and validate technical feasibility
- Oversee User Acceptance Testing (UAT) and ensure quality deliverables
- Monitor KPIs such as claim turnaround time, denial rates, and compliance adherence
- Provide guidance and mentorship to junior analysts
- Prepare executive-level reports and presentations on claims performance and regulatory compliance
Requirements:
- Bachelor's degree in Healthcare Administration, Business, or related field (Master's preferred)
- 5+ years of experience in healthcare claims analysis, with strong Medicare/Medicaid expertise
- In-depth knowledge of CMS regulations, HIPAA compliance, and state-specific Medicaid requirements
- Hands-on experience with claims adjudication systems (Facets, QNXT, or similar)
- Strong analytical and problem-solving skills with proficiency in SQL and data visualization tools (Power BI, Tableau)
- Excellent communication and stakeholder management skills
- Experience in Agile methodology and healthcare IT projects
- Familiarity with EDI transactions (837, 835) and ICD/CPT coding
- Ability to lead cross-functional teams and manage multiple priorities