Senior Medicaid Business Analyst; Configuration & Policy

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.

at Gainwell, 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. This role supports end-to-end domain delivery by translating state and federal Medicaid policy and program requirements into product features, system configuration, and design artifacts.

The Business Analyst works closely with the Domain Lead, Technical Analysts, and cross-functional teams and acts as a domain and policy subject matter expert (SME) to ensure successful implementation and operational readiness.

• Acts as the primary Domain SME, serving as a trusted advisor to the Engagement Lead (EL) on business processes and associated regulatory and operational impacts.
• Ensures compliance alignment by validating that solution design and configuration conform to CMS guidance, state policy, and documented business rules.
• Supports the EL with in-scope negotiations and change control, providing domain expertise to assess scope trade-offs and the functional, regulatory, and operational impacts of change requests.
• Lead and participate in collaborative requirements and design sessions with clients and internal teams to validate functional and technical needs.
• Interpret state and federal Medicaid policy, regulations, and program rules and translate them into product features, system configuration, business rules, and design artifacts.
• Serve as a policy and domain SME, supporting the Domain Lead with analysis, interpretation, and solution recommendations.
• Develop and maintain domain design documentation, with the Design Document as a core deliverable, covering workflows, interfaces, X12 EDI transactions, letters, and reports.
• Ensure accuracy, completeness, and traceability of requirements and acceptance criteria.
• Document and communicate domain-level decisions, risks, assumptions, and dependencies, assessing downstream impacts.

Support domain-specific configuration and implementation activities within Design, Development, and Implementation (DDI) projects. Responsible for configuration and partner with technical teams to ensure solutions align with approved design documentation, Medicaid policy interpretation, and documented business rules. Key configurations include but not limited to:

• Claims:
  Edits, pricing, benefit limits, adjudication logic
• Plan:
  Contracts, benefits, programs, fee schedules
• Provider:
  Provider types, specialties, contracts, enrollment, credentialing
• Member:
  Eligibility, benefits, benefit plans, demographic
• Pharmacy: RX benefits, RX claims processing

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

• Support operational readiness activities, including environment, data, process, and staffing readiness.
• Provide domain and policy input for Operational Readiness Reviews (ORR),…