Senior Business Analyst – Medicaid Pharmacy Claims, MMIS

Responsibilities and Duties

• Lead requirements gathering, analysis, documentation, and validation for Medicaid pharmacy claims, MMIS processing, eligibility, prior authorization, and related workflows.
• Facilitate discussions with business, vendor, and technical teams to define requirements, resolve issues, and align on scope and priorities.
• Translate business, policy, and regulatory needs into clear requirements, user stories, process flows, business rules, and acceptance criteria.
• Analyze current and future-state processes to identify gaps, risks, dependencies, and improvement opportunities.
• Maintain key project artifacts such as traceability matrices, workflow documentation, interface mappings, and decision logs.
• Partner with testing teams to develop test scenarios, support SIT and UAT, manage defects, and validate business outcomes.
• Support implementation, change requests, issue resolution, and production support activities.
• Mentor junior analysts and promote consistent analysis, documentation, and collaboration practices.

Requirements

• Bachelor’s degree in Business, Information Systems, Healthcare Administration, Public Administration, or a related field; equivalent experience may be considered.
• 5+ years of experience as a Business Analyst or Systems Analyst supporting complex healthcare or public‑sector systems.
• 3+ years of experience with Medicaid claims processing, MMIS/MES platforms, or Medicaid pharmacy operations.
• Strong experience documenting business and functional requirements, process flows, user stories, use cases, and acceptance criteria.
• Experience with requirements traceability, change control, and support across the project lifecycle.
• Hands‑on experience with test planning, test case development, SIT, UAT, defect management, and validation of business outcomes.
• Experience working in Agile and/or hybrid SDLC environments with cross‑functional teams.
• Strong facilitation, communication, analytical, and documentation skills.
• Proficiency with tools such as Azure DevOps, Jira, SharePoint, Microsoft Office, Visio, and SQL.