Technical Business Analysis Engineer III (Medicaid)

About the Role

Responsibilities

• Gather, analyze, and document business and system requirements with stakeholders.
• Investigate suspended claims, operational issues, and system defects; identify root causes and recommend solutions.
• Collaborate with development and QA teams to design, test, and validate enhancements and operational improvements.
• Assess Medicaid policy updates, CMS mandates, and client directives for impacts on processes and system functionality.
• Research billing manuals, design documentation, and regulatory guidance to resolve issues and support decisions.
• Document and improve business processes; serve as liaison between business and technical teams.
• Develop test strategies, scenarios, and plans to validate state policy requirements and payment methodologies.
• Support User Acceptance Testing and implementation of system changes.
• Analyze data and trends for actionable insights and operational reporting.

Requirements

• Experience interpreting and applying Medicaid policies, CMS regulations, and state healthcare program requirements.
• Strong knowledge of Medicaid claims processing and payment systems and ability to apply payment methodologies in analysis and testing.
• Strong analytical, troubleshooting, and problem-solving skills.
• Ability to research and evaluate documentation, policies, billing manuals, and technical specifications independently.
• Excellent communication and collaboration with business and technical stakeholders.
• Ability to manage multiple priorities in a fast-paced environment.

Preferred Qualifications

• Eight or more years of healthcare industry experience, preferably in the MMIS domain.
• Experience supporting large-scale Medicaid systems and operational processes.
• Working knowledge of SQL and relational database concepts.
• Presentation, facilitation, and organizational skills; proficiency with Microsoft Office applications.
• Ability to work independently and drive initiatives from analysis through implementation.

Flexible Working

• The role is remote and can be performed from home.

Benefits and Growth

• Health and welfare benefits begin on the first day of employment.
• Retirement savings support, paid time off, and career growth opportunities are offered.