Medicaid Business Analyst
Woonsocket, RI | Fully Remote
Job Description
Title: Technical Medicaid Business Analyst
Location: Work from Home
Schedule: Mon – Fri, 8:30AM – 5:00PM EST
Note: This is a W2 contract role – C2C, 1099, & 3 rd party candidates WILL NOT be considered
The Technical Medicaid Business Analyst serves as a critical bridge between Medicaid business operations and technical delivery teams. This role is responsible for translating 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 will partner closely with business stakeholders, IT teams, vendors, and external partners to ensure Medicaid systems and solutions meet contractual, regulatory, and operational expectations.
Position Responsibilities:
- Medicaid Business & Regulatory Analysis
o Analyze federal and state Medicaid regulations, contract requirements, and policy guidance, and translate them into clear business and functional requirements
o Support Medicaid program areas such as eligibility, enrollment, claims, encounters, care management, provider management, quality, and compliance
o Interpret CMS, state agency, and contractual changes and assess operational and system impacts
- Technical Requirements & Solution Design
o Develop detailed functional and technical requirements, including use cases, process flows, data mappings, interface specifications, and system configuration needs
o Collaborate with IT, data, and vendor teams to design and validate technical solutions that align with Medicaid business needs
o Support system enhancements, defect resolution, and new implementations across core Medicaid platforms (e.g., claims, encounters, care management, data warehouse)
- Data & Integration Support
o Analyze data flows between Medicaid systems, vendors, and external entities (state agencies, CMS, providers)
o Support reporting, analytics, and regulatory submissions (e.g., encounter data, quality measures, financial reporting)
o Assist with data validation, reconciliation, and root-cause analysis for Medicaid data issues
- Stakeholder & Cross-Functional Collaboration
o Serve as a liaison between Medicaid business teams, IT, finance, compliance, and external vendors
o Facilitate requirements workshops, design sessions, and stakeholder reviews
o Clearly communicate complex technical concepts to nontechnical stakeholders and business priorities to technical teams
- Testing & Implementation Support
o Support system testing activities, including test planning, test case development, and user acceptance testing (UAT)
o Validate that solutions meet Medicaid business and regulatory requirements prior to deployment
o Support golive activities and postimplementation issue resolution
- Documentation & Governance
o Maintain clear, auditready documentation of requirements, decisions, and approvals
o Ensure alignment with Medicaid governance, SDLC, and change management processes
o Support audits, regulatory reviews, and compliance inquiries, as needed
Position Qualifications:
- 5+ years of experience as a Business Analyst, with direct Medicaid or healthcare payer experience
- Strongunderstanding 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
- Stronganalytical, documentation, and problem-solving skills
- Experience supporting Medicaid managed care organizations (MCOs) or state Medicaid programs preferred
- Familiarity with Medicaid healthcare payer systems such as claims platforms, encounter processing, care management systems, or eligibility/enrollment platforms preferred
- Experience with data analysis, SQL, or data warehouse concepts preferred
- Knowledge of CMS reporting, state encounter submissions, or quality programs preferred
- Experience with Agile, SAFe, or traditional SDLC methodologies preferred
- A minimum of a Bachelor’s Degree in Business, Information Systems, Health Administration, Public Health, or other related field
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