Medicaid Business Analyst
Atlanta, GA (Onsite role from day 1)
6 Months +
Employment Type W2
Key Responsibilities:
- Analyze Medicaid eligibility and enrollment business processes, workflows, and system functionality.
- Interpret federal and state Medicaid policies and translate requirements into functional specifications.
- Support eligibility determination processes for programs including MAGI, Non-MAGI, CHIP, SNAP integration, and related public assistance programs.
- Work closely with operations teams, system integrators, and development teams to resolve eligibility and enrollment issues.
- Perform root cause analysis for eligibility defects, enrollment discrepancies, and data inconsistencies.
- Develop business requirements documents (BRDs), functional specifications, user stories, and process flows.
- Support UAT, SIT, regression testing, and production validation activities.
- Assist with data analysis, reconciliation, and reporting related to eligibility and enrollment transactions.
- Coordinate with state agencies, vendors, and business stakeholders on system enhancements and operational initiatives.
- Provide production support and guidance during critical implementation and renewal periods.
- Participate in policy workshops, backlog grooming sessions, and operational review meetings.
- Mentor junior analysts and provide subject matter expertise to project teams.
Required Qualifications
- 15+ years of experience in Medicaid eligibility and enrollment systems and operations.
- Strong understanding of Medicaid eligibility rules, enrollment lifecycle, renewals, Stacking, notices, and case management processes.
- Mandatory experience working with large system integrators, healthcare vendors, or state Medicaid programs.
- Experience working on large state Medicaid programs and integrated eligibility systems.
- Experience supporting Medicaid modernization or eligibility transformation initiatives.
- Experience working with business and technical teams in Agile and/or Waterfall environments.
- Experience with defect triage, production support, and operational stabilization activities.
Mandatory skill:
Skill Category
Skill / Competency
Description
Expected Level (D03)
Evaluation Criteria
Medicaid Domain
Eligibility & Enrollment
End-to-end lifecycle incl MAGI, Non-MAGI, CHIP, renewals
Expert
Deep functional expertise
Medicaid Domain
Policy Interpretation
Federal & State Medicaid policies
Expert
Translate to requirements
Business Analysis
BRD & Functional Specs
Documentation, user stories, workflows
Expert
Clear & complete artifacts
Business Analysis
Process Analysis
Business process and workflow analysis
Expert
Optimization ability
Systems
Integrated Eligibility Systems
Experience in large Medicaid systems
Expert
Hands-on transformation work
Systems
Platforms (Pega/Curam/SF)
Eligibility platforms experience
Advanced
Configuration exposure
Testing
UAT/SIT/Regression
Support testing lifecycle
Advanced
Defect-free release support
Production Support
Defect Triage
Issue analysis and RCA
Expert
Fast resolution
Production Support
Stabilization
Post go-live support
Expert
Operational stability
Data
Data Analysis
Reconciliation, reporting
Advanced
Insights from datasets
Data
SQL/Power BI
Querying and reporting
Advanced
Hands-on capability
Stakeholder Mgmt
Vendor & State Coordination
Work with agencies and vendors
Expert
Effective coordination
Stakeholder Mgmt
Executive Communication
Leadership Interactions
Advanced
Clear communication
Agile/Delivery
Agile & Waterfall
Working in both models
Advanced
Delivery adaptability
Leadership
Mentoring
Guide junior analysts
Advanced
Knowledge sharing