Business Analyst from Medicaid Domain

 Share genuine and senior profile and should have medicaid domain experience.

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

Location: Remote
Duration: 12+ months contract
Experience: 13+ years

 

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.

 

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.

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