Medicaid Business Analyst

Job Description

Job Description

About role:

We are seeking a highly motivated and experienced Business Analyst to join our dynamic technology team. The ideal candidate will possess a strong understanding of Medicaid operations, healthcare systems, and business processes. You will play a pivotal role in bridging the gap between business requirements and technological solutions, contributing to the enhancement and optimization of our platform. Your analytical skills, attention to detail, and collaborative nature will be critical in ensuring the successful execution of various projects and initiatives.

You will be assisting a high-energy team in implementing an end-to-end cloud-based, integrated solution for our clients in a role with very high potential for career growth. Primary responsibilities will include gaining business user consensus via sessions to define functional requirements as part of an implementation of a COTS application used to manage healthcare claims payment integrity.

Candidate needs to have experience in the Medicaid Enterprise Certification Lifecycle (MECT) and Medicaid Policy and Operations as well as experience in working with healthcare payers.., and

Candidate is expected to have experience in technical aspects of the Business Analyst role, and will work with other team members, Medicaid state agency to facilitate the requirements elaboration and the requirements traceability aspects of the project.

Your future duties and responsibilities

• Collaborate with stakeholders, including program managers, policy experts, and technical teams, to elicit, document, and analyze business requirements related to healthcare operations.
• Lead Joint Application Design (JAD) sessions to gain consensus among multiple stakeholder groups
• Evaluate and assess current processes, identifying opportunities for improvement, automation, and increased efficiency
• Work closely with the business and technology development teams to translate business requirements into technical specifications, ensuring seamless integration of technology solutions
• Document business requirements by developing use cases and maintaining requirements traceability across the SDLC
• Prepare comprehensive documentation, including business requirements, functional specifications, use cases, process flows, and user guides
• Work with the team to create meeting agendas, meeting minutes, project plans, contingency plans, disaster recovery plans and other documentation required by the MECT lifecycle process.

Required qualifications to be successful in this role

• Minimum 10 years in Information Technology as a Business Analyst on large-scale, healthcare system implementations
• A minimum of 5 years Medicaid (MMIS) or Healthcare payer background is required
• Strong understanding of Medicaid policies, regulations, and healthcare operations
• Detail-oriented mindset with the ability to translate complex requirements into clear and concise documentation
• Demonstrated experience in conducting Joint Application Design (JAD) sessions and gaining consensus among multiple vendors and customer stakeholder groups
• Demonstrated experience in developing use cases, managing requirements traceability, and a working knowledge of requirements management repository tools
• Strong interpersonal and communication skills, including the ability to gain consensus among multiple stakeholder groups
• Strong verbal and written communication skills, with the ability to communicate abstract technical concepts to a business layperson audience
• Adaptability to work in a fast-paced environment and manage multiple projects simultaneously

• Desired Qualifications:

• Working familiarity with CMS (Center for Medicare and Medicaid Services) MITA framework and the MECT (Medicaid Enterprise Certification Toolkit)
• Familiarity with HIPPA-compliant messaging formats such as HL7, X12, NCPDP and NIEM

Education:

• Bachelor’s Degree in a relevant field such as Healthcare Administration, Business Administration, Information Technology, or a related discipline or equivalent experience
• A Master's Degree or relevant certifications, such as Certified Business Analyst Professional (CBAP) or Certified Healthcare Business Analyst (CHBA), are preferred but not mandatory

• Collaborate with testing teams to develop test cases, execute testing, and validate system changes against business requirements
• Facilitate communication between technical teams and non-technical stakeholders, ensuring a clear understanding of project objectives, progress, and outcomes
• Analyze data to identify trends, patterns, and insights that can inform strategic decisions and system enhancements

Alivia Analytics is helping customers Achieve Healthcare Payment Integrity, Finally. By turning mountains of data into actionable answers, Alivia Analytics does the heavy lifting – delivering the accuracy, confidence and speed our customers need to solve their healthcare payment integrity challenges. Through the Alivia Analytics Healthcare Payment Integrity Suite TM we help private and public healthcare payers achieve payment integrity globally. In the US alone, up to 10% of every dollar spent is attributed to Fraud, Waste or Abuse that amounts to up to 370 Billion dollars lost annually. If your ambition is to grow your responsibilities and career while building world class analytic SaaS systems and fixing a huge problem for social good, please come and join us.

Company Description

Alivia Analytics is helping customers Achieve Healthcare Payment Integrity, Finally. By turning mountains of data into actionable answers, Alivia Analytics does the heavy lifting – delivering the accuracy, confidence and speed our customers need to solve their healthcare payment integrity challenges. Through the Alivia Analytics Healthcare Payment Integrity Suite TM we help private and public healthcare payers achieve payment integrity globally. In the US alone, up to 10% of every dollar spent is attributed to Fraud, Waste or Abuse that amounts to up to 370 Billion dollars lost annually. If your ambition is to grow your responsibilities and career while building world class analytic SaaS systems and fixing a huge problem for social good, please come and join us.