Job description

• 12+ years of Business Analysis experience with strong Medicaid MMIS/MES domain expertise. • Hands-on experience with Health Enterprise, QNXT, Facets, or similar Medicaid claims platforms. • Strong experience in at least 2 of 3 areas: Claims, Member/Eligibility, Finance . • Experience with Medicaid claims processing, adjudication, adjustments/voids, encounters, Medicare crossover, remittance, and payment processing . • Strong knowledge of Medicaid eligibility, enrollment, aid categories, benefit packages, MCO/FFS, TPL, capitation, ASO, and FFP . • Experience modernizing/replacing legacy MMIS/mainframe systems with commercial Medicaid platforms. • Ability to create BRDs, FRDs, user stories, functional designs, process flows, data mappings, and acceptance criteria . • Experience working closely with Development, QA, Architecture, SIT/UAT, and defect triage teams. • Knowledge of HIPAA X12 837/835, COBA/crossover, interfaces, and Medicaid financial accounting .

Requirements

Must-haves

12+ years of Business Analysis experience with strong Medicaid MMIS/MES domain expertise.
Hands-on experience with Health Enterprise, QNXT, Facets, or similar Medicaid claims platforms.
Strong experience in at least 2 of 3 areas: Claims, Member/Eligibility, Finance .
Experience with Medicaid claims processing, adjudication, adjustments/voids, encounters, Medicare crossover, remittance, and payment processing .
Strong knowledge of Medicaid eligibility, enrollment, aid categories, benefit packages, MCO/FFS, TPL, capitation, ASO, and FFP .
Experience modernizing/replacing legacy MMIS/mainframe systems with commercial Medicaid platforms.
Ability to create BRDs, FRDs, user stories, functional designs, process flows, data mappings, and acceptance criteria .
Experience working closely with Development, QA, Architecture, SIT/UAT, and defect triage teams.
Knowledge of HIPAA X12 837/835, COBA/crossover, interfaces, and Medicaid financial accounting .

Nice-to-haves

None flagged.

Application prep

Use the role’s language and application details while tailoring your materials.

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Effort: medium