Functional Consultant

Required Skills/ Qualifications:
Experience as a Functional Analyst, Business Analyst, or Consultant within healthcare, Medicaid, or government-sponsored programs.
Excellent stakeholder management and communication skills with the ability to collaborate effectively with State agencies, Managed Care Organizations (MCOs), and third-party vendors.
Strong understanding of Medicaid operations, LTSS programs, member enrollment processes, and managed care environments.
Practical experience working with HIPAA 834 and/or 278 transaction sets, including transaction structures, loops, segments, code values, and implementation guides.
Experience creating business and functional requirements documents (BRDs/FRDs), workflow diagrams, data mapping specifications, and interface documentation.
Proven experience supporting development and testing teams through requirements clarification, UAT, issue resolution, and defect management.
Proficiency with project and documentation tools such as JIRA, Confluence, Visio, and Microsoft Office Suite.
Experience supporting both HIPAA 834 Enrollment and HIPAA 278 Authorization transactions.
Familiarity with Managed Long-Term Care (MLTC) enrollment workflows and non-MAGI eligibility processes.
Working knowledge of SQL and data analysis techniques for reconciliation, validation, and root-cause investigation.