Technical Medicaid Business Analyst - 100% Remote

Job Title: Technical Medicaid Business Analyst Job Location: 100% Remote Role Job Duration: 6 months of contract with possible extension Job Summary

• The Technical Medicaid Business Analyst serves as a critical bridge between Medicaid business operations and technical delivery teams.
• This role translates federal and state Medicaid requirements, health plan business needs, and operational workflows into detailed functional requirements that support system configuration, data integration, reporting, and compliance.
• The analyst partners closely with business stakeholders, IT teams, vendors, and external partners to ensure Medicaid systems and solutions meet contractual, regulatory, and operational expectations.

Key Responsibilities:

• Medicaid Business & Regulatory Analysis.
• Analyze federal and state Medicaid regulations, contract requirements, and policy guidance and translate them into clear business and functional requirements.
• Support Medicaid program areas such as eligibility, enrollment, claims, encounters, care management, provider management, quality, and compliance.
• Interpret CMS, state agency, and contractual changes and assess operational and system impacts.

Technical Requirements & Solution Design

• Develop detailed functional and technical requirements, including use cases, process flows, data mappings, interface specifications, and system configuration needs.
• Collaborate with IT, data, and vendor teams to design and validate technical solutions that align with Medicaid business needs.
• Support system enhancements, defect resolution, and new implementations across core Medicaid platforms (e.g., claims, encounters, care management, data warehouse).

Data & Integration Support

• Analyze data flows between Medicaid systems, vendors, and external entities (state agencies, CMS, providers).
• Support reporting, analytics, and regulatory submissions (e.g., encounter data, quality measures, financial reporting).
• Assist with data validation, reconciliation, and root-cause analysis for Medicaid data issues.

Stakeholder & Cross-Functional Collaboration

• Serve as a liaison between Medicaid business teams, IT, finance, compliance, and external vendors.
• Facilitate requirements workshops, design sessions, and stakeholder reviews.
• Clearly communicate complex technical concepts to non-technical stakeholders and business priorities to technical teams.

Testing & Implementation Support

• Support system testing activities, including test planning, test case development, and user acceptance testing (UAT).
• Validate that solutions meet Medicaid business and regulatory requirements prior to deployment.
• Support go-live activities and post-implementation issue resolution.

Documentation & Governance:

• Maintain clear, audit-ready documentation of requirements, decisions, and approvals.
• Ensure alignment with Medicaid governance, SDLC, and change management processes.
• Support audits, regulatory reviews, and compliance inquiries as needed.

Required Qualifications

• Bachelor's degree in Business, Information Systems, Health Administration, Public Health, or a related field (or equivalent experience).
• 5+ years of experience as a Business Analyst, with direct Medicaid or healthcare payer experience.
• Strong understanding of Medicaid programs, managed care operations, and state/federal compliance requirements.
• Experience translating business requirements into technical specifications.
• Experience working with IT teams, system vendors, and data/reporting teams.
• Strong analytical, documentation, and problem-solving skills.

Preferred Qualifications

• Experience supporting Medicaid managed care organizations (MCOs) or state Medicaid programs.
• Familiarity with Medicaid healthcare payer systems such as claims platforms, encounter processing, care management systems, or eligibility/enrollment platforms.
• Experience with data analysis, SQL, or data warehouse concepts.
• Knowledge of CMS reporting, state encounter submissions, or quality programs.
• Experience with Agile, SAFe, or traditional SDLC methodologies.

Core Competencies

• Medicaid subject matter expertise.
• Technical and systems thinking.
• Requirements elicitation and documentation.
• Data analysis and validation.
• Stakeholder communication.
• Regulatory and compliance awareness.
• Attention to detail and audit readiness.

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