Advisor Technical Business Analyst - Medicaid FHIR Architecture & Interoperability

Gainwell Technologies is seeking a Technical Business Analyst to support Medicaid modernization and interoperability initiatives. The role translates Medicaid policies, CMS mandates, and client requirements into scalable FHIR-based architecture, leads data mapping and profiling, supports API design, and collaborates with architects, engineers, state agencies, and vendors.

Responsibilities:

• Serve as a FHIR‑focused technical business analyst supporting Gainwell’s Medicaid interoperability and data exchange solutions
• Translate state Medicaid business requirements, CMS mandates, and client‑specific policies into FHIR‑aligned technical requirements
• Support architecture decisions related to FHIR‑based integration patterns, including APIs, canonical data models, and transformation strategies
• Partner with solution architects to ensure interoperability designs are scalable, reusable, and consistent with Gainwell enterprise standards
• Serve as a technical translator between Medicaid business stakeholders, state agencies, and engineering teams
• Clearly explain FHIR architecture and interoperability concepts to non‑technical audiences
• Support governance reviews, standards compliance, and documentation required by state Medicaid programs and CMS
• Lead analysis and documentation for mapping Medicaid data to and from FHIR (R4), including: MMIS data models ↔ FHIR; X12 (270/271, 834, 837, 835) ↔ FHIR; HL7 v2 ↔ FHIR
• Define and maintain FHIR profiles, extensions, value sets, and implementation guidance appropriate for Medicaid use cases
• Support FHIR API design by reviewing resource structures, payloads, search parameters, and business rules
• Ensure FHIR implementations align with: CMS Interoperability and Prior Authorization rules; Patient Access and Provider Directory API requirements; Gainwell reusable integration assets and patterns
• Produce clear, detailed technical artifacts, including: FHIR data mapping documents; API and integration use cases; Sequence diagrams and process flows; Acceptance criteria and validation rules
• Actively collaborate with: Integration and platform engineers; Enterprise and solution architects; State Medicaid SMEs and external vendors
• Review and validate transformation logic, schemas, and API contracts
• Support SIT and UAT by validating data accuracy, business compliance, and end‑to‑end interoperability

Requirements:

• Nine or more years of experience working as a business analyst or ‘requirements translator' between technical and non-technical personnel
• Knowledge of Microsoft Excel advanced features such as macros and/or relational database software
• Ability to clearly and concisely translate technical requirements to a non-technical audience
• Skills working with business processes and re-engineering
• Curiosity to solve complex problems and strong interpersonal skills to interact with and influence clients and team members
• A caring team leader who motivates and coaches less experienced resources
• Strong systems thinking and architectural mindset
• Able to balance policy, data, and technology considerations
• Excellent written and verbal communication
• High attention to detail and regulatory compliance
• Comfortable influencing without authority across teams
• 3 or more years of Medicaid and Medicare experience
• Familiarity with Gainwell's Provider+ Product data and system design
• Experience supporting CMS interoperability initiatives (Patient Access API, Provider Directory API, PA API)
• Familiarity with integration platforms and tools:
  • Postman, Swagger/OpenAPI
  • Interface engines (Mirth, Rhapsody)
  • Cloud‑based integration services
• Experience working on Medicaid transformation or modular MMIS modernization projects
• Agile or hybrid SDLC experience in large enterprise environments