Business Analyst III

Location: 100% Remote (WFH)
Duration: Contract (Potential Extension)

Important Note:

• Please ensure City and State are mentioned at the top of the resume

The Technical Medicaid Business Analyst acts as a key liaison between Medicaid business operations and technical teams. This role focuses on translating federal and state Medicaid requirements, business needs, and operational workflows into detailed functional and technical specifications.

The ideal candidate will collaborate with stakeholders, IT teams, and vendors to ensure systems and solutions meet regulatory, contractual, and operational requirements.

• Analyze federal and state Medicaid regulations and translate them into functional requirements

• Support core Medicaid areas: eligibility, enrollment, claims, encounters, care management, provider management, and compliance

• Interpret CMS and state-level changes and assess system and operational impact

• Develop detailed requirements including use cases, process flows, data mappings, and interface specifications

• Collaborate with IT and vendors to design and validate solutions

• Support system enhancements, implementations, and defect resolution across Medicaid platforms

• Analyze data flows between internal systems, vendors, and external entities (CMS, state agencies, providers)

• Support reporting, analytics, and regulatory submissions (encounter data, quality, financial reporting)

• Perform data validation, reconciliation, and root cause analysis

• Act as a liaison between business, IT, compliance, finance, and external partners

• Facilitate requirement gathering sessions, workshops, and design discussions

• Communicate technical concepts to non-technical stakeholders effectively

• Support test planning, test case development, and User Acceptance Testing (UAT)

• Ensure solutions meet business and regulatory requirements before deployment

• Assist with go-live and post-implementation support

• Maintain clear and audit-ready documentation

• Ensure adherence to SDLC and change management processes

• Support audits and compliance reviews

• Manage release cycle activities and production support across projects

• Coordinate system-level and cross-project testing initiatives

• Develop and implement release testing strategies

• Track progress, dependencies, risks, and resource allocation for QA activities

• Communicate status updates to stakeholders and senior management

• Bachelors degree in Business, Information Systems, Health Administration, Public Health, or related field (or equivalent experience)

• 5+ years of Business Analyst experience in Medicaid or healthcare payer domain

• Strong understanding of Medicaid programs, managed care, and compliance requirements

• Experience translating business requirements into technical specifications

• Experience working with IT teams, vendors, and data/reporting teams

• Strong analytical, documentation, and problem-solving skills

• Experience with Medicaid Managed Care Organizations (MCOs) or state Medicaid programs

• Familiarity with healthcare payer systems (claims, encounters, care management, eligibility)

• Experience with SQL, data analysis, or data warehouse concepts

• Knowledge of CMS reporting, encounter submissions, and quality programs

• Experience with Agile, SAFe, or traditional SDLC methodologies