Medicaid Business Analyst

Job Overview

Requirement/Must Have:

• 15+ years of experience in Medicaid eligibility and enrollment systems and operations.
• Strong understanding of Medicaid eligibility rules, enrollment lifecycle, renewals, stacking, notices, and case management processes.
• Mandatory experience working with large system integrators, healthcare vendors, or state Medicaid programs.
• Experience working on large state Medicaid programs and integrated eligibility systems.
• Experience supporting Medicaid modernization or eligibility transformation initiatives.
• Experience working with business and technical teams in Agile and/or Waterfall environments.
• Experience with defect triage, production support, and operational stabilization activities.

Responsibilities:

• Analyze Medicaid eligibility and enrollment business processes, workflows, and system functionality.
• Interpret federal and state Medicaid policies and translate requirements into functional specifications.
• Support eligibility determination processes for programs including MAGI, Non-MAGI, CHIP, SNAP integration, and related public assistance programs.
• Work closely with operations teams, system integrators, and development teams to resolve eligibility and enrollment issues.
• Perform root cause analysis for eligibility defects, enrollment discrepancies, and data inconsistencies.
• Develop business requirements documents (BRDs), functional specifications, user stories, and process flows.
• Support UAT, SIT, regression testing, and production validation activities.
• Assist with data analysis, reconciliation, and reporting related to eligibility and enrollment transactions.
• Coordinate with state agencies, vendors, and business stakeholders on system enhancements and operational initiatives.
• Provide production support and guidance during critical implementation and renewal periods.
• Participate in policy workshops, backlog grooming sessions, and operational review meetings.
• Mentor junior analysts and provide subject matter expertise to project teams.