Business Analyst - CMdS Claims, Member & Finance Implementation (MES)
Remote
Long Term
Contract
12+ years
Domain: Medicaid Enterprise Systems (MES) | MMIS modernization | Claims / Member / Finance
Role Summary
Serve as Business Analyst for CMdS product development and implementation on a Medicaid modernization program. Translate legacy MMIS claims, member, and finance behavior and state Medicaid policy into CMdS functional design, requirements, and acceptance criteria. Partner with development, QA, architecture, and business stakeholders to deliver MES-aligned solutions that replace or integrate with legacy adjudication, eligibility/enrollment, and financial accounting processes.
Key Responsibilities
Delivery & Analysis
• 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 ...
Munesh
,
CYBER SPHERE LLC
