Advisor Business Analyst - Provider+

Gainwell Technologies provides technology solutions that help healthcare clients improve the health and well-being of the members they serve. The Advisor Business Analyst - Provider+ supports Medicaid Management Information Systems and Medicaid Pharmacy environments by translating policy and program requirements into product features, configurations, business rules, and design artifacts. The role serves as a domain subject matter expert across requirements, implementation, testing, operational readiness, and client engagement.

Responsibilities:

• Acts as the primary Domain Subject Matter Expert (SME) and trusted advisor to the Engagement Lead (EL), providing guidance on business processes and regulatory/operational impacts
• Ensures solution design and configuration align with CMS guidance, state policy, and documented business rules
• Supports in-scope negotiations and change control by evaluating scope trade-offs and associated functional, regulatory, and operational impacts
• Leads and participates in requirements and design sessions with clients and internal teams to validate business and technical needs
• Interprets federal and state Medicaid policy, translating it into product features, system configurations, business rules, and design artifacts
• Serves as a domain SME, supporting analysis, interpretation, and solution recommendations
• Develops and maintains domain design documentation (including Design Documents) covering workflows, interfaces, X12 EDI transactions, letters, and reports
• Ensures requirements and acceptance criteria are accurate, complete, and traceable
• Documents and communicates decisions, risks, assumptions, and dependencies, including downstream impacts
• Supports configuration and implementation activities across Design, Development, and Implementation (DDI)
• Partners with technical teams to ensure alignment with approved designs, policy interpretation, and business rules
• Reviews test cases for alignment with requirements and policy
• Provides SME support during System Integration Testing (SIT) and User Acceptance Testing (UAT)
• Assists with defect analysis, root cause investigation, resolution, retesting, and validation of functional readiness
• Supports operational readiness across environments, data, processes, and staffing
• Contributes domain expertise to Operational Readiness Reviews (ORR), parallel testing, and performance testing
• Assists with cutover planning, transition to operations, and hypercare support
• Partners closely with Domain Leads, technical teams, and stakeholders as a trusted SME
• Leads and supports client interactions, including requirements discussions, design reviews, and issue resolution
• Plans and delivers demos and walkthroughs to validate solutions against requirements
• Facilitates working sessions across business, configuration, and technical teams, and supports documentation, knowledge transfer, and ongoing operations

Requirements:

• 9+ years of hands‑on experience supporting healthcare system implementations, including MMIS solutions and Medicaid Pharmacy platforms
• Bachelor's degree in Computer Science, Information Systems, Health Informatics, or a related field
• Experience with QNXT or similar healthcare claims/encounter 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
• Proven ability to lead or support functional demonstrations, walkthroughs, and collaborative working sessions
• Strong documentation, facilitation, and analytical skills
• 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