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.