Gainwell Technologies
Business Analyst – Medicaid MMIS
Date: January 9, 2026
Location: Washington, DC, US 20005
Work Mode: Virtual (Exception only)
Be part of a team that harnesses cutting‑edge technology to improve the health and well‑being of the most vulnerable communities. Gainwell offers a flexible, growth‑oriented environment with generous vacation, educational assistance, and leadership development.
Summary As a Business Analyst – Medicaid MMIS, you will partner with clients, MCOs, providers, and third parties to translate operational needs into clear technical specifications for our product teams. This role requires leadership, rapid problem‑solving, and deep expertise in Medicaid workflows.
Your Role in Our Mission
Act as the primary functional liaison between the client, MCOs, and internal technical teams for all MMIS operations workflows.
Lead requirements‑gathering sessions and triage meetings to address surges in defects, change requests, and operational gaps.
Manage client expectations regarding system capabilities, timelines, and regulatory constraints.
Requirements Engineering
Analyze and document complex requirement issues such as Claims (FFS & Encounters), Financials, Capitation, Provider Enrollment, and more.
Translate high‑level policy changes or operational pain points into detailed User Stories, Functional Design Documents (FDDs), and Technical Specifications.
Validate that proposed technical solutions solve the business problem before development begins.
Requirement Issue Resolutions
Investigate root causes of systemic issues reported by providers or MCOs (e.g., mass claim denials, capitation payment errors, EDI rejection loops).
Collaborate with the Operations team to distinguish between system defects and user training gaps, creating workarounds or documentation as needed.
Serve as the Subject Matter Expert on Medicaid workflows, ensuring compliance with federal (CMS) and local (District) regulations.
Support the Compliance Manager in assessing the impact of new mandates on current system functionality.
Understand MITA 3.0 framework and CMS‑64 financial reporting.
What We’re Looking For
5+ years of Business Analysis experience in Healthcare IT, with at least 2 years in Medicaid MMIS or state‑level Eligibility & Enrollment systems.
Deep knowledge of core MMIS modules: Claims Adjudication, Encounters Processing, Financial Management, Provider Management, MCO Capitation, 837/835 EDI transactions.
Experience with ALM tools (JIRA, Microfocus ALM, SharePoint) for requirements traceability.
Strong understanding of SDLC in an Agile/Hybrid environment.
Proficiency in Microsoft Excel (advanced features, macros) and relational database concepts.
PowerPoint and presentation skills.
Soft Skills
Client‑Facing Confidence: Proven ability to lead meetings with government clients and assertively push back when necessary.
Crisis Management: Ability to remain calm and structured during high‑volume “surge” periods.
Curiosity to solve complex problems and strong interpersonal skills to influence clients and team members.
Team Leadership: Motivates and coaches less experienced resources.
What You Should Expect in This Role
Fully remote from Continental United States locations only.
Occasional travel (0‑10%).
Video camera use during all interviews and initial orientation.
Application deadline: January 15, 2025.
Equal Opportunity Employer: Gainwell Technologies is an Equal Opportunity Employer. All qualified applicants receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other legally protected characteristics.
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Be part of a team that harnesses cutting‑edge technology to improve the health and well‑being of the most vulnerable communities. Gainwell offers a flexible, growth‑oriented environment with generous vacation, educational assistance, and leadership development.
Summary As a Business Analyst – Medicaid MMIS, you will partner with clients, MCOs, providers, and third parties to translate operational needs into clear technical specifications for our product teams. This role requires leadership, rapid problem‑solving, and deep expertise in Medicaid workflows.
Your Role in Our Mission
Act as the primary functional liaison between the client, MCOs, and internal technical teams for all MMIS operations workflows.
Lead requirements‑gathering sessions and triage meetings to address surges in defects, change requests, and operational gaps.
Manage client expectations regarding system capabilities, timelines, and regulatory constraints.
Requirements Engineering
Analyze and document complex requirement issues such as Claims (FFS & Encounters), Financials, Capitation, Provider Enrollment, and more.
Translate high‑level policy changes or operational pain points into detailed User Stories, Functional Design Documents (FDDs), and Technical Specifications.
Validate that proposed technical solutions solve the business problem before development begins.
Requirement Issue Resolutions
Investigate root causes of systemic issues reported by providers or MCOs (e.g., mass claim denials, capitation payment errors, EDI rejection loops).
Collaborate with the Operations team to distinguish between system defects and user training gaps, creating workarounds or documentation as needed.
Serve as the Subject Matter Expert on Medicaid workflows, ensuring compliance with federal (CMS) and local (District) regulations.
Support the Compliance Manager in assessing the impact of new mandates on current system functionality.
Understand MITA 3.0 framework and CMS‑64 financial reporting.
What We’re Looking For
5+ years of Business Analysis experience in Healthcare IT, with at least 2 years in Medicaid MMIS or state‑level Eligibility & Enrollment systems.
Deep knowledge of core MMIS modules: Claims Adjudication, Encounters Processing, Financial Management, Provider Management, MCO Capitation, 837/835 EDI transactions.
Experience with ALM tools (JIRA, Microfocus ALM, SharePoint) for requirements traceability.
Strong understanding of SDLC in an Agile/Hybrid environment.
Proficiency in Microsoft Excel (advanced features, macros) and relational database concepts.
PowerPoint and presentation skills.
Soft Skills
Client‑Facing Confidence: Proven ability to lead meetings with government clients and assertively push back when necessary.
Crisis Management: Ability to remain calm and structured during high‑volume “surge” periods.
Curiosity to solve complex problems and strong interpersonal skills to influence clients and team members.
Team Leadership: Motivates and coaches less experienced resources.
What You Should Expect in This Role
Fully remote from Continental United States locations only.
Occasional travel (0‑10%).
Video camera use during all interviews and initial orientation.
Application deadline: January 15, 2025.
Equal Opportunity Employer: Gainwell Technologies is an Equal Opportunity Employer. All qualified applicants receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other legally protected characteristics.
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