Senior Business Analyst - Medicaid Pharmacy (MMIS)

About the role

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary

As a Senior Business Analyst - Medicaid Pharmacy (MMIS) at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges.

Details

• Supports business, policy, and technical execution across one or more functional domains within MMIS Medicaid Management Information Systems (MMIS) and/or the Medicaid Pharmacy environment.
• Supported domains may include Member, Provider, Claims (Medicaid, Dental and/or Pharmacy), Finance, Plan and Care Management, and Business Relationship Management.
• Supports end-to-end domain delivery by translating state and federal Medicaid policy and program requirements into product features, system configuration, and design artifacts.
• Works closely with the Domain Lead, Technical Analysts, and cross-functional teams to ensure successful implementation and operational readiness.

Requirements & Design

• Ensures compliance alignment by validating that solution design and configuration adhere to CMS guidance, state policy, and documented business rules.
• Supports the Engagement Lead (EL) in scope negotiations and change control, providing domain expertise to evaluate trade-offs and assess functional, regulatory, and operational impacts of change requests.
• Led and participates in collaborative requirements and design sessions with clients and internal teams.
• Interprets Medicaid policy, regulations, and program rules, translating them into product features, system configurations, and design artifacts.
• Pairs with the Domain Lead to provide analysis, interpretation, and solution recommendations.
• Develops and maintains comprehensive design documentation—centered on the Design Document—covering workflows, interfaces, X12 EDI transactions, letters, and reports.
• Ensures requirements and acceptance criteria are accurate, complete, and traceable.
• Documents and communicates key decisions, risks, assumptions, and dependencies, including downstream impacts.

Build / Configuration

• Supports domain-specific configuration and implementation within DDI projects.
• Responsible for configuring solutions and collaborating with technical teams to ensure alignment with approved designs, Medicaid policy interpretations, and business rules.
• Key configuration areas include: Claims: edits, pricing, benefit limits, adjudication logic, Plan: contracts, benefits, programs, fee schedules, Provider: types, specialties, enrollment, credentialing, contracts, Member: eligibility, demographics, benefit plans, Pharmacy: Rx benefits and claims processing.

Testing

• Reviews test cases to ensure alignment with requirements, policy interpretation, and acceptance criteria.
• Provides SME support during System Integration Testing (SIT) and User Acceptance Testing (UAT).
• Aids in defect analysis, root-cause investigation, resolution, retesting, and validation of functional readiness.

Operational Readiness & Deployment

• Supports operational readiness, including environment, data, process, and staffing preparation.
• Contributes domain and policy input to Operational Readiness Reviews (ORR), parallel testing, and performance testing.
• Aids in cutover planning, transition to operations, and hypercare support.

Collaboration & Client Engagement

• Works closely with the Domain Lead and Technical Analysts as a trusted domain and policy SME.
• Leads and supports client engagement activities, including requirements discussions, design reviews, and issue resolution.
• Plans and delivers functional demos and solution walkthroughs to validate alignment with client needs.
• Facilitates collaborative sessions with stakeholders and cross-functional teams.
• Supports documentation, knowledge transfer, and ongoing operational support.

What We're Looking For

• Bachelor’s degree in Computer Science, Information Systems, Health Informatics, or a related field.
• 5 to 8 years of hands-on experience supporting healthcare system implementations, including MMIS solutions and Medicaid Pharmacy platforms.
• Experience with QNXT or similar healthcare claims/encounter management systems.
• Strong knowledge of state and federal Medicaid policy, regulations, and program rules (required).
• Strong understanding of Medicaid domains, including claims, member, provider, and prior authorization processes.
• Demonstrated experience translating policy and program rules into system requirements, configuration support, and design artifacts.
• Strong knowledge of SQL is required, particularly for data analysis and validation.
• Strong client communication skills, with experience interacting directly with business stakeholders.
• Proven ability to lead or support functional demonstrations, walkthroughs, and collaborative working sessions.
• Strong documentation, facilitation, and analytical skills.
• Experience working in SDLC and Agile delivery environments.

What Sets You Apart

• Knowledge of MITA (Medicaid Information Technology Architecture).
• Experience with system integrations, EDI/X12 transactions, analytics, and reporting.
• Familiarity with state and federal healthcare regulations and compliance standards.

What You Should Expect

• Full remote options from Contiguous US locations only.
• Video cameras must be used during all interviews, as well as during the initial week of orientation.
• This posting is intended for pipelining. This is a developing position therefore the job description is subject to change.
• The pay range for this position is $69,400 - $99,200 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.