Senior Business Analyst – Medicaid/MMIS SME

The Computer Merchant, LTD (TCM) is seeking a Senior Business Analyst with expertise in the Medicaid domain and MMIS systems. The role involves acting as a subject matter expert, leading requirements gathering, and ensuring compliance with relevant regulations while mentoring other analysts.

Responsibilities:

• Act as a Medicaid/MMIS SME across claims, eligibility, enrollment, and provider modules
• Lead requirements gathering, business process analysis, and documentation (BRDs, FRDs, user stories)
• Translate complex business needs into clear functional and technical requirements
• Collaborate with stakeholders, product owners, and development teams
• Ensure compliance with CMS guidelines, HIPAA, and state Medicaid regulations
• Support defect management, and production support
• Identify process improvements and support system modernization initiatives
• Mentor business analysts and contribute to Agile delivery

Requirements:

• 15+ years of experience in Medicaid domain, with strong MMIS experience and MITA
• Deep understanding of claims processing, eligibility, and provider management systems
• Understanding of the forms HCFA 1500, UB04, ADA. Elements, processing, outcomes
• Proven experience in business analysis, stakeholder engagement, and documentation
• Hands-on experience with Agile/Scrum methodologies
• Strong analytical, communication, and problem-solving skills
• Experience with MMIS platforms (Facets, QNXT, MES, etc.)
• Knowledge of HL7/FHIR and healthcare data exchange standards
• Experience working with state Medicaid agencies or healthcare payers