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Business Analyst - CMdS Claims, Member & Finance Implementation (MES)

Computer Merchant, Ltd., The

Richmond, Virginia • Today

Full-time

USD 50.00 - 60.00 per hour

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SAP Governance, Risk and Compliance (GRC) Implementation Consultant

Trigyn Technologies, Inc.

New York, New York • Today

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PharmaSuite MES Consultant

Purple Drive Technologies LLC

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Tool Maker C - 75506

Boeing

Renton, Washington • Today

Full-time

Compensation information provided in the description

Change Implementation Consultant

Motion Recruitment Partners, LLC

Charlotte, North Carolina • Today

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$46.53 - $52.43

SAP S/4HANA Security Architecture and Implementation Consultant

Trigyn Technologies, Inc.

New York, New York • Today

Contract, Third Party

DOE

Site MES IT Coordinator

HCM Staffing and Consulting

Cincinnati, Ohio • 10d ago

Easy Apply

Contract

$40 - $50

Payroll Implementation Consultant

Stefanini

Irving, Texas • 5d ago

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Contract

$60 - $65 /hr

Digital Engineer - MES/Opstrakker & Werum

Saicon Consultants Inc.

Bloomfield, New Jersey • 3d ago

Easy Apply

Contract, Third Party

Depends on Experience

Business Analyst — CMdS Claims, Member & Finance Implementation (MES)

Group Nine

Remote • Today

Easy Apply

Contract, Third Party

Depends on Experience

Manhattan Active WMS Consultant

Innova Solutions, Inc

Chicago, Illinois • 4d ago

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Contract

Depends on Experience

QuickBooks Implementation Consultant (Permanent)

JDA TSG

Remote • 4d ago

Easy Apply

Full-time

$90,000 - $95,000

APRISO MES Consultant

Rcube IT llc

Remote • 11d ago

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Contract

80+

SAP Apriso MES Consultant - Remote

Data Wave Technologies Inc

Remote • Today

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Contract

GrowthLoop Implementation Consultant

Savvyan Technologies

Dallas, Texas • Today

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Depends on Experience

SAP QM/PP consultant Fiori , SAP implementation project, Stock, Manufacturing

Tanisha Systems, Inc.

Fort Worth, Texas • 14d ago

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Contract, Third Party

Depends on Experience

Oracle FCCS Implementation & Production Support Consultant

Sagarsoft

Remote • 4d ago

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Contract, Third Party

Depends on Experience

SAP Transportation Management Implementation consultant

Centraprise Corp

Irving, Texas • 6d ago

Easy Apply

Full-time

120,000 - 150,000

Senior Veeva CTMS Consultant (Greenfield Implementation)

Econosoft

Remote • 10d ago

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Contract

Depends on Experience

Workday Techno functional Implementation Consultant

Kutir Inc

Sunnyvale, California • Today

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Third Party, Contract

Adobe Analytics implementation (Mobile Analytics) Consultant

Hexaware Technologies, Inc

Remote • 25d ago

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Full-time

$160 - $170

Only w2 - HighRadius Implementation Consultant - Remote

Nachway Consulting

Remote • 4d ago

Easy Apply

Contract

80 - 90

MES Consultant

Rcube IT llc

Remote • 18d ago

Easy Apply

Contract

70 - 80

Job Details

Skills

QNXT
Facets
COBOL
Mainframe
Media
Medicare
Filing
Payments
Embedded Systems
Agile
Software Development Methodology
Facilitation
Documentation
Communication
HIPAA
ASC X12
Business Analysis
Business Analytics
Product Development
Development Testing
Financial Accounting
User Stories
Functional Design
Pricing
Editing
Budget
Enterprise Architecture
Accounting
Process Flow
Data Mapping
Gap Analysis
Collaboration
Quality Assurance
Test Scenarios
Regression Analysis
Finance
System Integration Testing
Acceptance Testing
MMIS
Medicaid
Auditing
Reporting
MES
Interfaces
Change Management
Training
Release Notes
TCM
DICE

QNXT
Facets
COBOL
Mainframe
Media
Medicare
Filing
Payments
Embedded Systems
Agile
Software Development Methodology
Facilitation
Documentation
Communication
HIPAA
ASC X12
Business Analysis
Business Analytics
Product Development
Development Testing
Financial Accounting
User Stories
Functional Design
Pricing
Editing
Budget
Enterprise Architecture
Accounting
Process Flow
Data Mapping
Gap Analysis
Collaboration
Quality Assurance
Test Scenarios
Regression Analysis
Finance
System Integration Testing
Acceptance Testing
MMIS
Medicaid
Auditing
Reporting
MES
Interfaces
Change Management
Training
Release Notes
TCM
DICE

Summary

JOB TITLE: Business Analyst - CMdS Claims, Member & Finance Implementation (MES)
JOB LOCATION: Remote
WAGE RANGE*: $50-60/hr
JOB NUMBER: 26-01186

REQUIRED EXPERIENCE:
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.

Preferred qualifications

Hands-on CMdS configuration or implementation (Claims, Member, Finance, Reference, Service Auth).
Familiarity with HIPAA X12 (837/835), COBA/crossover, EVV-related claim flows.
Experience supporting CMS MES certification artifacts and evidence packages.
Prior lead BA experience on multi-module MES releases.

JOB DESCRIPTION

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 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.

Equal opportunity employer as to all protected groups, including protected veterans and individuals with disabilities

* While an hourly range is posted for this position, an eventual hourly rate is determined by a comprehensive salary analysis which considers multiple factors including but not limited to: job-related knowledge, skills and qualifications, education and experience as compared to others in the organization doing substantially similar work, if applicable, and market and business considerations. Benefits offered include medical, dental and vision benefits; dependent care flexible spending account; 401(k) plan; voluntary life/short term disability/whole life/term life/accident and critical illness coverage; employee assistance program; sick leave in accordance with regulation. Benefits may be subject to generally applicable eligibility, waiting period, contribution, and other requirements and conditions. Benefits offered are in accordance with applicable federal, state, and local laws and subject to change at TCM's discretion.

#Dice

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: cxtcml
Position Id: 26-01187
Posted 2 days ago

Fitment

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Remote

•

Today

Business Analyst CMdS Claims, Member & Finance Implementation (MES) Location: Engagement: Experience:12+ years Domain:Medicaid Enterprise Systems (MES) | MMIS modernization | Claims / Member / Finance Role summary Serve as Business Analyst forCMdS product development and implementationon 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 developme

Easy Apply

Contract, Third Party

Depends on Experience

Business Analyst with Medicaid/MMIS (Claims/Finance/Members) experience- Remote

Remote

•

3d ago

12+ years of Business Analysis experience with strong Medicaid MMIS/MES domain expertise.Hands-on experience with Health Enterprise, QNXT, Facets, or similar Medicaid claims platforms.Strong experience in at least 2 of 3 areas: Claims, Member/Eligibility, Finance.Experience with Medicaid claims processing, adjudication, adjustments/voids, encounters, Medicare crossover, remittance, and payment processing.Strong knowledge of Medicaid eligibility, enrollment, aid categories, benefit packages, MCO/

Easy Apply

Contract, Third Party

$50

Medicaid Business Analyst Integrated Eligibility Systems // Local to NC

No location provided

•

Today

Engagement Type Contract Short Description The Department of Health and Human Services (NC DHHS) is seeking a NC FAST Business Analyst to support development and implementation of the eligibility system, and lead business analysis activities and manage projects for Medicaid-specific solutions. Complete Description This position requires experience with Agile Methodologies and knowledge of Medicaid program rules, policies, and procedures. The NC FAST Business Analyst is expected to participate

Easy Apply

Full-time, Part-time, Contract, Third Party

Senior Business Systems SME

Remote

•

Today

Job Description Senior Techno-Functional SME (Medicaid Applications) Role Overview We are looking for a highly experienced Senior Techno-Functional Subject Matter Expert (SME) with 12+ years of experience in Medicaid systems, Medicaid claims processing and regulatory compliance. Model N Flex/ PbyN experience remains highly desirable along with SQL, PL/SQL and Cognos expertise. This position plays a critical role in bridging business needs and technology, driving product implementations, integra

Easy Apply

Contract, Third Party

80 - 90