Business Analyst - Medicaid Prior Authorizations

Business Analyst – Medicaid Prior Authorizations

Location:

Quincy, MA Work Arrangement:
Hybrid (onsite and remote)

Schedule:

Monday-Friday, 9:00 a.m.–5:00 p.m. Pay Rate:
Up to $64.29 per hour, depending on experience

Position Summary We are hiring a Business Analyst with Medicaid prior authorization (PA) expertise for our client located in the Quincy, MA area. The person hired for this position will join an established Medicaid Management Information System (MMIS) team, supporting provider reimbursement, claims processing, and system enhancements for a state Medicaid program. This is a hybrid position in the Quincy, MA, area.

Candidates must be able to reliably commute to this location.

Please note:

No C2C, Subcontracting or Visa Sponsorship of any kind is available for this position. The Business Analyst will work closely with business stakeholders, project managers, developers, systems analysts, quality assurance teams, and external vendors to gather and document requirements, support system design and development, develop and execute test plans, and facilitate successful implementation of system changes. The ideal candidate will have a strong understanding of healthcare operations, Medicaid systems, claims processing, and prior authorizations.

Experience with the systems development life cycle (SDLC), data analysis, and SQL is highly desirable. This position follows a hybrid work model, combining onsite work in Quincy with remote work as needed. The schedule may be adjusted based on business and operational requirements.

• Lead and participate in joint application design sessions with business stakeholders.
• Gather, document, and validate business and system requirements.
• Support all phases of the project life cycle, including gap analysis, requirements gathering, design, development, testing, implementation, and post-release stabilization.
• Develop test strategies, test scenarios, and test cases based on documented requirements.
• Execute and review test runs, validate results, and provide testing sign-off as appropriate.
• Ensure system changes meet business requirements and align with applicable state and federal regulations.
• Collaborate with vendors to ensure requirements are clearly defined, implemented, and tested.
• Support the development of end-user training materials and system documentation.
• Monitor system changes during release stabilization, help identify issues, and support the development and implementation of corrective actions.
• Communicate project updates, system changes, and implementation details to impacted stakeholders.
• Represent the MMIS team in business meetings and provide support to program staff, vendors, and other stakeholders.
• Perform data queries and analysis to support business and system requirements.
• Provide backup support to other Business Analysts as needed.

• Experience in business analysis supporting multiple stages of the system development life cycle.
• Strong knowledge of healthcare claims processing, payment transactions, and prior authorization workflows.
• Understanding of Medicaid systems and healthcare plan operations; direct Medicaid experience is preferred.
• Familiarity with HIPAA claims and payment transaction processing.
• Proficiency in SQL and strong data analysis skills.
• Excellent written and verbal communication skills, including requirements documentation.
• Strong analytical and problem-solving skills, with the ability to independently evaluate issues, document findings, and recommend solutions.
• Ability to work independently and collaboratively with cross-functional project teams.
• Strong interpersonal skills and the ability to work effectively with business users, project managers, developers, QA teams, systems analysts, vendors, and external organizations.
• Knowledge of Agile methodologies and interoperability standards, including X12, is a plus.

Education and Experience Bachelor's degree or higher in Business, Information Technology, Healthcare Administration, or a related field, with at least three years of relevant experience. Equivalent experience in a healthcare administration setting may be considered.

Compensation Pay is up to $64.29 per hour, depending on experience.

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