Business Analyst III

Work Type: 100% Remote (WFH)
Duration: 3+ Months (Possible Extension)
Client Max Bill Rate: ***

Important Instructions:

• Please review the updated job requirements carefully before submitting candidates
• Emphasis on business operations experience and strong communication skills
• Candidates must be able to bridge business and IT teams effectively
• Many previous candidates were rejected due to poor communication skills
• Add City/State at the top of the resume

The Technical Medicaid Business Analyst acts as a key bridge between Medicaid business operations and technical delivery teams. This role translates federal/state Medicaid requirements, business needs, and workflows into detailed functional and technical requirements supporting system configuration, integrations, reporting, and compliance.

The analyst collaborates closely with business stakeholders, IT teams, vendors, and external partners to ensure solutions meet regulatory and operational expectations.

• Analyze federal/state Medicaid regulations, contracts, and policies
• Translate requirements into business and functional specifications
• Support areas such as eligibility, enrollment, claims, encounters, care management, provider management, quality, and compliance
• Interpret CMS/state changes and assess system and operational impacts

• Develop functional and technical requirements (use cases, workflows, data mapping, interfaces)
• Partner with IT, data, and vendors to design solutions aligned with business needs
• Support enhancements, defect resolution, and implementations across Medicaid platforms

• Analyze data flows across systems, vendors, and external entities (CMS, state agencies, providers)
• Support reporting, analytics, and regulatory submissions (encounters, quality, financials)
• Perform data validation, reconciliation, and root cause analysis

• Act as liaison between business, IT, finance, compliance, and vendors
• Facilitate workshops, design sessions, and stakeholder reviews
• Communicate complex technical concepts to business users and vice versa

• Support test planning, test case creation, and UAT
• Ensure solutions meet business and regulatory requirements
• Assist with go-live and post-implementation support

• Maintain audit-ready documentation of requirements and decisions
• Ensure adherence to SDLC, governance, and change management processes
• Support audits, compliance reviews, and regulatory inquiries

• Strong business operations experience with ability to solve complex business challenges
• Excellent verbal and written communication skills
• Ability to clearly explain complex topics to both technical and non-technical audiences
• Proven experience working as a bridge between business and IT teams
• Strong experience translating business needs into actionable technical requirements
• Bachelors degree in Business, Information Systems, Health Administration, Public Health, or related field (or equivalent experience)
• 5+ years of Business Analyst experience with Medicaid or healthcare payer background
• Strong understanding of Medicaid programs, managed care, and compliance
• Experience working with IT teams, vendors, and data/reporting teams
• Strong analytical, documentation, and problem-solving skills

• Experience with Medicaid MCOs or state Medicaid programs
• Familiarity with claims, encounters, care management, eligibility, or enrollment systems
• Experience with SQL, data analysis, or data warehouse concepts
• Knowledge of CMS reporting, encounter submissions, or quality programs
• Experience with Agile, SAFe, or traditional SDLC

• Medicaid domain expertise
• Technical and systems thinking
• Requirements gathering and documentation
• Data analysis and validation
• Stakeholder communication
• Regulatory and compliance knowledge
• Attention to detail and audit readiness

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