Senior Business Analyst - Medicaid Provider Enrollment Modernization

Accountabilities: • Facilitate discovery and requirements sessions with Medicaid policy, provider enrollment, operations, technical, security, and vendor stakeholders.

• Analyze current provider enrollment processes, workflows, business rules, system interfaces, forms, notices, and operational challenges to identify improvement opportunities.

• Elicit, document, validate, maintain, and trace business, functional, nonfunctional, data, and integration requirements throughout the project lifecycle.

• Translate business needs into detailed user stories, use cases, process flows, business rules, acceptance criteria, and requirements traceability documentation.

• Define requirements for provider-facing portals that enable providers to initiate, save, submit, and track enrollment applications and supporting documentation.

• Document portal page flows, navigation, user roles, data requirements, and workflows in collaboration with UI/UX and development teams.

• Support requirements related to authentication, role-based access, accessibility, security, and integration with enterprise identity-management solutions.

• Analyze and document workflow automation requirements covering provider screening, licensing validation, risk assignment, notifications, site visits, fraud indicators, provider status changes, and work-queue management.

• Collaborate with OnBase, MMIS, portal, and integration teams to define data mappings, interface requirements, ingestion and validation rules, exception handling, and bidirectional data exchanges.

• Analyze provider enrollment data involving National Provider Identifiers, taxonomy, licenses, affiliations, revalidation, ownership, individual and group relationships, and ordering, referring, and prescribing providers.

• Identify opportunities to reduce manual processing, strengthen data quality, improve workflow visibility, and automate enrollment activities.

• Coordinate with business and technical stakeholders to resolve requirement gaps, manage changes, clarify dependencies, and assess downstream impacts.

• Review system designs and technical documentation to verify alignment with approved business requirements.

• Participate in Agile delivery activities including sprint planning, backlog refinement, demonstrations, defect reviews, and stakeholder discussions.

• Develop test scenarios and expected outcomes based on approved requirements, business rules, and acceptance criteria.

• Support system integration testing, user acceptance testing, regression testing, defect triage, and validation of implemented functionality.

• Maintain end-to-end traceability from initial business needs through design, development, testing, and implementation.

• Prepare project artifacts including status updates, meeting notes, decision logs, risk and issue documentation, and other required deliverables.

Requirements

• 7+ years of experience as a Business Analyst supporting complex information technology, systems modernization, or enterprise transformation initiatives.

• Strong experience eliciting, documenting, validating, and managing detailed business and functional requirements.

• Proven ability to develop process flows, user stories, use cases, business rules, data requirements, acceptance criteria, and requirements traceability matrices.

• Experience collaborating with business stakeholders, developers, architects, testers, operations teams, project leadership, and third-party vendors.

• Experience analyzing system interfaces, data exchanges, workflow automation, integrations, and cross-system dependencies.

• Background supporting software development, systems integration, testing, defect resolution, and implementation activities.

• Strong facilitation, analytical, problem-solving, documentation, and written and verbal communication skills.

• Ability to translate complex policy, operational, and business needs into clear, actionable requirements for technical teams.

• Strong organizational skills with the ability to manage multiple workstreams, priorities, requirements, and stakeholders in a complex environment.

• Experience working within Agile or hybrid Agile delivery methodologies.

• Bachelor’s degree in business, information systems, healthcare administration, computer science, or a related discipline; equivalent relevant professional experience may be considered.

• Experience with Medicaid, healthcare, or Health and Human Services programs is preferred.

• Knowledge of Medicaid provider enrollment processes, including screening, revalidation, licensing, affiliations, sanctions, exclusions, ownership, and provider data management, is a strong plus.

• Experience supporting an MMIS or another large-scale public-sector healthcare system is preferred.

• Experience with OnBase workflows, document management, work queues, electronic forms, or comparable workflow automation platforms is advantageous.

• Experience with provider-facing portals, online application systems, APIs, system interfaces, data ingestion, validation, and bidirectional integrations is preferred.

• Familiarity with provider data and screening sources such as NPPES, LEIE, and SAM.gov is a plus.

• Knowledge of National Provider Identifiers, provider taxonomy, ordering/referring/prescribing requirements, and provider affiliation structures is beneficial.

• Familiarity with identity-management technologies such as Okta and SAML , as well as ADA and WCAG accessibility requirements, is preferred.

• Experience supporting state government or federally funded modernization programs is advantageous.

• Familiarity with Jira, Azure DevOps, Confluence, Visio , or comparable requirements and process-modeling tools is preferred.

• Business analysis or Agile certifications such as CBAP, CCBA, PMI-PBA, Certified Scrum Product Owner , or equivalent are a plus.

Benefits

• Fully remote position within the United States .

• Competitive compensation aligned with experience and qualifications.

• Medical, dental, and vision insurance with employer premium assistance.

• Additional insurance coverage, including life and disability benefits.

• Paid time off.

• 401(k) retirement savings plan.

• Health Savings Account (HSA).

• Training courses and opportunities for continuous professional development.

• Corporate wellness program.

• Exposure to complex Medicaid and public-sector healthcare modernization initiatives.

• Opportunity to work with multidisciplinary teams across business, technology, operations, and government program environments.

• Family-oriented culture with an emphasis on work-life balance.

• Opportunities to expand technical and business expertise through diverse projects and client engagements.

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