Functional Consultant

Location: Albany, NY, US • Posted: 20-Oct-2026

About the role

Functional Consultant to support the Enrollment track of a NY State Medicaid LTSS modernization program. The role focuses on requirements, solution design articulation, and HIPAA transaction support including 834 and 278 interchanges.

Responsibilities

• Gather and document business and functional requirements (BRDs/FRDs)
• Create process flows, data mappings, and interface specifications
• Support HIPAA 834 and 278 transaction interchanges — segments, loops, code sets, and companion guides
• Work with NY eMedNY inbound/outbound transaction interchange
• Collaborate with State, MCO, and vendor stakeholders
• Partner with development and QA teams on requirements clarification, testing, and defect triage
• Perform SQL/basic data analysis for reconciliation and defect investigation

Requirements

• 4–7 years of experience as a Business / Functional Consultant in healthcare and/or public sector programs
• Strong Medicaid and LTSS knowledge, including enrollment and managed care
• Hands-on experience with HIPAA 834 or 278 transactions, including segments, loops, code sets, and companion guides
• Experience with NY eMedNY and related inbound/outbound transaction interchange
• Ability to produce BRDs/FRDs, process flows, data mappings, and interface specifications
• Strong client-facing communication skills; able to work with State, MCO, and vendor stakeholders
• Experience partnering with development and QA teams on requirements clarification, testing, and defect triage
• Proficiency with JIRA, Confluence, Visio, and MS Office

Qualifications (Preferred)

• Experience supporting both HIPAA 834 and 278 transactions
• 3+ years supporting Enrollment on a Medicaid platform
• Work experience with eMedNY
• Familiarity with Managed Long Term Care enrollment concepts and non-MAGI workflows
• SQL/basic data analysis for reconciliation and defect investigation

Skills & Tools

• JIRA, Confluence, Visio, MS Office
• SQL / basic data analysis
• HIPAA 834 and 278 transaction standards
• NY eMedNY platform

Benefits

• Long-Term Stability: Multi-year opportunities with room to grow
• Comprehensive Health Coverage: Quality healthcare benefits for you and your family
• Future Planning: 401(k) program for financial security
• GC Assistance: Immediate Green Card processing support, if required