Open role
Business Analyst - Medicaid and Claims -Remote with Travel
Required qualifications
- 12+ years business analysis experience in Medicaid MMIS / MES, with deep hands-on work in at least two of: Claims, Member/Eligibility-Enrollment, Finance/Financial Accounting.
- Proven experience developing and implementing claims systems / MMIS / MES platforms, such as CMds, Health Enterprise, QNXT, Facets, or comparable commercial Medicaid/claims suites.
- Experience modernizing or replacing legacy MMIS (COBOL/mainframe or equivalent) with a commercial Medicaid platform.
- Strong Medicaid domain knowledge, including:
- o FFS vs managed care; capitation vs ASO / administrative services models
- o Claim types, media sources, edits/EOBs, adjustments/voids, Medicare crossover, encounters
- o Aid categories, benefit packages, eligibility spans, timely filing, TPL concepts
- o Provider payments, remittance advice, budget/object codes, COS, fund source / FFP concepts
- o CMS / state Medicaid policy drivers relevant to MES implementation and certification
- Demonstrated ability to write clear functional design and acceptance criteria for complex adjudication and financial rules.
- Experience working embedded with development and QA teams in Agile or hybrid SDLC.
- Excellent facilitation, documentation, and stakeholder communication skills.
- Preferred qualifications
- Hands-on CMdS configuration or implementation (Claims, Member, Finance, Reference, Service Auth).
- Familiarity with HIPAA X12 (837/835), COBA/crossover, EVV-related claim flows.
- Experience supporting CMS MES certification artifacts and evidence packages.
- Prior lead BA experience on multi-module MES releases.
Remote Skills: Adjudication, Administrative Skills, Agile Programming Methodologies, Budgeting, Business Analysis, Centers for Medicare and Medicaid Services (CMS), Cobol Programming Language, Communication Skills, Content Management Systems (CMS), Documentation, Embedded Systems, Finance, Financial Accounting, HIPAA (Health Insurance Portability and Accountability Act), Mainframe Computer, Managed Care, Medicaid, Medicare, Quality Assurance, Software Development Lifecycle (SDLC), Technical/Engineering Design, Time Management, Writing Skills The Dignify Solutions, LLC