Senior or Advisor Business Analyst - Provider+

Summary

As a Senior or Advisor Business Analyst - Provider+ 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. Here are the details on this position.

We have two upcoming roles that we are currently sourcing.

These positions support 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.

These roles 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 and acts as a domain and policy subject‑matter expert (SME) to ensure successful implementation and operational readiness.

Your role in our mission

Requirements & Design

• Acts as the primary Domain Subject Matter Expert (SME) and trusted advisor to the Engagement Lead (EL), providing guidance on business processes and regulatory/operational impacts.
• Ensures solution design and configuration align with CMS guidance, state policy, and documented business rules.
• Supports in-scope negotiations and change control by evaluating scope trade-offs and associated functional, regulatory, and operational impacts.
• Leads and participates in requirements and design sessions with clients and internal teams to validate business and technical needs.
• Interprets federal and state Medicaid policy, translating it into product features, system configurations, business rules, and design artifacts.
• Serves as a domain SME, supporting analysis, interpretation, and solution recommendations.
• Develops and maintains domain design documentation (including Design Documents) covering workflows, interfaces, X12 EDI transactions, letters, and reports.
• Ensures requirements and acceptance criteria are accurate, complete, and traceable.
• Documents and communicates decisions, risks, assumptions, and dependencies, including downstream impacts.
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Build / Configuration

Builds key areas including:

• Supports configuration and implementation activities across Design, Development, and Implementation (DDI). 
• Partners with technical teams to ensure alignment with approved designs, policy interpretation, and business rules.

Configures key functional areas including:

• Claims: edits, pricing, benefit limits, adjudication logic
• Plan: contracts, benefits, programs, fee schedules
• Provider: provider types, specialties, enrollment, credentialing
• Member: eligibility, demographics, benefit plans
• Pharmacy: RX benefits and claims processing

Testing

• Reviews test cases for alignment with requirements and policy.
• 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 across environments, data, processes, and staffing.