Business Analyst
Full Time
Remote
Depends on Experience
Mind Ware Inc
Fitment
Dice Job Match Score™
🔢 Crunching numbers...
Job Details
Skills
- Business Analyst
- FFS
- MMIS
- MES
Summary
Role: Senior Business Analyst Medicaid Enterprise Systems
Location: Virgina (Remote)
Domain: Medicaid Enterprise Systems (MES) | MMIS modernization | Claims / Member / Finance
______________
______________
Key responsibilities
Own requirements and functional design for assigned CMdS modules (Claims, Member, Finance, and related interfaces).
Define epics, user stories, and definition of done; prioritize against Medicaid policy, MES certification goals, and release plans.
Facilitate working sessions; clarify requirements for developers and QA; resolve functional questions during build and test.
Track scope, dependencies, risks, and decisions; maintain traceability from legacy rule to CMdS design to test evidence.
Functional design (Claims, Member, Finance)
Claims: Lead functional design for claim intake, claim type assignment, validity/pricing edits, adjustment/void, crossover, encounters, remittance, and related edit disposition behavior; map legacy rules to CMdS configuration and customizations.
Member: Lead design for eligibility spans, aid category / benefit package assignment, enrollment, MCO/FFS indicators, and interfaces from state eligibility systems into CMdS Member.
Finance: Lead design for payment cycles, budget account / category of service, fund splits, ASO / F/EA and other administrative payment paths, financial transactions, and reporting/accounting controls.
Produce BRDs, FRDs, process flows, data mapping, gap analysis, and configuration workbooks suitable for build and UAT.
Collaboration with Development & QA
Work side-by-side with developers on design walkthroughs, edge cases, and defect triage.
Partner with QA to define test scenarios, expected results, and regression packs (positive/negative, adj/void, crossover, encounter, finance posting).
Support SIT, UAT, and parallel/run-compare activities against legacy MMIS outcomes.
Validate that implementations meet Medicaid policy and MES operational readiness (security, audit, reporting, interfaces).
Stakeholder & MES engagement
Run workshops with business owners, SMEs, fiscal, and operations.
Align designs to CMS MES expectations (modularity, interoperability, standards-based interfaces, certification evidence).
Support change management: training outlines, release notes, and operational runbooks for CMdS go-live.
______________
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 Conduent CMdS (Conduent Medicaid Suite), 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:
FFS vs managed care; capitation vs ASO / administrative services models
Claim types, media sources, edits/EOBs, adjustments/voids, Medicare crossover, encounters
Aid categories, benefit packages, eligibility spans, timely filing, TPL concepts
Provider payments, remittance advice, budget/object codes, COS, fund source / FFP concepts
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
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
- Dice Id: 91172318
- Position Id: 9088428
- Posted 5 hours ago
Company Info
About Mind Ware Inc
Mind Ware Inc partners with organizations to support their technology hiring needs, with a focus on contract and project-based roles. We work on behalf of our client partners to source and place qualified technical professionals across a range of disciplines. Our team reviews resumes on an ongoing basis and connects candidates with opportunities that align with their skills, experience, and availability.
Create job alert
Never miss an opportunity! Create an alert based on the job you applied for.Similar Jobs
It looks like there aren't any Similar Jobs for this job yet.
Search all similar jobs