Senior Business Analyst - Medicaid Pharmacy (MMIS

Senior Business Analyst
- Medicaid Pharmacy (MMIS)

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You'll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance.

We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary As a Senior Business Analyst
- Medicaid Pharmacy (MMIS) at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community's most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare's biggest challenges.

The Senior Business Analyst 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 to ensure successful implementation and operational readiness.

Requirements & Design Ensures compliance alignment by validating that solution design and configuration adhere to CMS guidance, state policy, and documented business rules. Supports the Engagement Lead (EL) in scope negotiations and change control, providing domain expertise to evaluate trade-offs and assess functional, regulatory, and operational impacts of change requests. Leads and participates in collaborative requirements and design sessions with clients and internal teams.

Interprets Medicaid policy, regulations, and program rules, translating them into product features, system configurations, and design artifacts. Partners with the Domain Lead to provide analysis, interpretation, and solution recommendations. Develops and maintains comprehensive design documentation—centered on the Design Document—covering workflows, interfaces, X12 EDI transactions, letters, and reports. Ensures requirements and acceptance criteria are accurate, complete, and traceable. Documents and communicates key decisions, risks, assumptions, and dependencies, including downstream impacts.

Build / Configuration Supports domain-specific configuration and implementation within DDI projects. Responsible for configuring solutions and collaborating with technical teams to ensure alignment with approved designs, Medicaid policy interpretations, and business rules. Key configuration areas include:
Claims: edits, pricing, benefit limits, adjudication logic Plan: contracts, benefits, programs, fee schedules Provider: types, specialties, enrollment, credentialing, contracts Member: eligibility, demographics, benefit plans Pharmacy:
Rx benefits and claims processing Testing Reviews test cases to ensure alignment with requirements, policy interpretation, and acceptance criteria. Provides SME support during System Integration Testing (SIT) and User Acceptance Testing (UAT). Assists with defect analysis, root-cause investigation, resolution, retesting, and validation of functional readiness. Operational Readiness & Deployment Supports operational readiness, including environment, data, process, and staffing preparation. Contributes domain and policy input to Operational Readiness Reviews (ORR), parallel testing, and performance testing.

Assists with cutover planning, transition to operations, and hypercare support. Collaboration & Client Engagement Works closely with the…