Overview
Remote
$40 - $50
Full Time
No Travel Required
Skills
Medicaid
HL7
HIPAA
MCO
Regulatory Compliance
Business Analyst
Job Details
Role: Business Analyst- Medicaid Membership (MCO Experience Required)
Location: USA (Remote)
Business Analyst Job Description Medicaid Membership (MCO Experience Required)
Required Skills & Experience
- Minimum 5+ years working at an MCO or Medicaid-focused environment in business operations and systems.
- Experience supporting or implementing Medicaid membership SaaS or hosted platforms.
- Good understanding of MCO operations and systems around Medicaid, MLTC, CHIP, DSNP lines of businesses
- Familiarity with work requirement tracking, exemptions, and compliance reporting.
- Strong understanding of Medicaid membership lifecycle: eligibility, enrollment, disenrollment, premium billing, reconciliation, and reporting.
- Familiarity with state Medicaid agency interactions (834/820 transactions, roster management, state audits, compliance reporting).
- Experience with regulatory compliance and CMS/state Medicaid rules (including work requirements).
- Hands-on experience with Medicaid membership systems, portals, or core admin platforms.
- Knowledge of healthcare data standards (HIPAA, 834, 820, HL7, FHIR) would be a plus.
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