Job Title: Management Analysts
Location: Falls Church, VA,
Employer: 4Consulting, Inc
Position Type: Full Time
Worksite: Remote
Position Summary
4Consulting, Inc is seeking a qualified Management Analysts to support technology consulting, application development, systems analysis, testing, data management, cybersecurity, infrastructure, or project delivery services for client projects. The selected candidate will perform duties consistent with the client’s project requirements and company delivery standards.
Essential Duties and Responsibilities
The candidate will be responsible for:
Own requirements gathering and functional design for assigned CMdS modules, including Claims, Member, Finance, and related interfaces; develop epics, user stories, acceptance criteria, process flows, and configuration workbooks.
Analyze and translate legacy MMIS rules and Medicaid policies into functional designs covering claims intake, adjudication, adjustments, voids, encounters, eligibility, enrollment, member benefits, payment cycles, financial transactions, and accounting controls.
Collaborate with development and QA teams to clarify requirements, conduct design walkthroughs, resolve functional questions, define test scenarios, support defect triage, and participate in SIT, UAT, regression, and parallel testing.
Coordinate with state agencies, business owners, fiscal teams, operations, and technical stakeholders to manage scope, dependencies, risks, and decisions while aligning solutions with CMS MES modularity, interoperability, security, audit, reporting, and certification expectations.
Minimum Qualifications
The position requires:
Education:
Bachelor’s degree in Computer Science, Information Technology, Engineering, Business, or related field, or equivalent combination of education and experience.
Experience:
12+ years of business analysis experience in Medicaid MMIS/MES environments, with hands-on expertise in at least two areas: Claims, Member/Eligibility and Enrollment, or Finance/Financial Accounting.
Experience developing and implementing Medicaid claims systems, MMIS/MES platforms, or commercial Medicaid solutions such as Conduent CMdS, Health Enterprise, QNXT, Facets, or comparable platforms.
Technical Skills:
Conduent CMdS, MMIS/MES Platforms, Medicaid Claims Processing, Eligibility and Enrollment, Financial Accounting, Functional Requirements, Business Requirements, Data Mapping, Agile/Scrum, HIPAA X12 (837/835)
Business / Domain Skills:
Experience supporting large-scale State Government Health and Human Services (HHS) applications, particularly Medicaid, Medicaid Enterprise Systems (MES/MMIS), Medicaid Eligibility and Enrollment, and related public-benefit programs. Experience working within complex government environments involving program-specific business rules, integrated applications, data exchanges, regulatory requirements, and multiple state, federal, and vendor stakeholders.
Experience designing Medicaid claims and adjudication processes, including fee-for-service (FFS), managed care, claim types, claim edits, EOBs, adjustments, voids, Medicare crossover, encounters, remittance advice, and third-party liability (TPL).
Experience supporting Medicaid member and eligibility operations, including eligibility spans, aid categories, benefit packages, enrollment, MCO/FFS indicators, timely filing requirements, and interfaces with state eligibility systems.
Experience supporting Medicaid financial operations, including provider payments, payment cycles, capitation, ASO/F/EA administrative payment models, budget and object codes, categories of service, fund sources, federal financial participation (FFP), and financial reporting.
Experience analyzing program policies, business rules, operational processes, and stakeholder needs and translating them into business requirements, functional specifications, process flows, and system requirements.
Communication:
Ability to communicate with technical and business stakeholders.
Documentation:
Ability to prepare project documentation, status updates, and deliverables.
Work Authorization:
Must be legally authorized to work in the United States. Sponsorship may be considered where permitted by company policy and project requirements.
Certification Required
Not Specified
Travel Required
None Specified
Supervisory Role
No
Preferred Qualifications
Hands-on experience with Conduent CMdS configuration or implementation across Claims, Member, Finance, Reference, or Service Authorization modules.
Familiarity with HIPAA X12 transactions (837/835), COBA and Medicare crossover, and EVV-related claim workflows.
Experience supporting CMS MES certification documentation, certification evidence packages, and multi-module Medicaid enterprise releases.
Equal Employment Opportunity Statement
4Consulting, Inc is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, veteran status, citizenship status, immigration status were protected by law, or any other legally protected status. All candidates will be evaluated based on job-related qualifications, experience, skills, availability, and ability to perform the essential duties of the position.
