Business Analyst - Medicaid And Claims -Remote With Travel
The Dignify Solutions, LLCAlbuquerque, NM
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Overview
Remote
On-site
Job Description
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 CMds, 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:
- o FFS vs managed care; capitation vs ASO / administrative services models
- o Claim types, media sources, edits/EOBs, adjustments/voids, Medicare crossover, encounters
- o Aid categories, benefit packages, eligibility spans, timely filing, TPL concepts
- o Provider payments, remittance advice, budget/object codes, COS, fund source / FFP concepts
- o 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.
- Preferred qualifications
- Hands-on CMdS configuration or implementation (Claims, Member, Finance, Reference, Service Auth).
- Familiarity with HIPAA X12 (837/835), COBA/crossover, EVV-related claim flows.
- Experience supporting CMS MES certification artifacts and evidence packages.
- Prior lead BA experience on multi-module MES releases.
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FAQs About Business Analyst - Medicaid And Claims -Remote With Travel Jobs at The Dignify Solutions, LLC
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This job at The Dignify Solutions, LLC is located in Albuquerque, NM, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.
What pay range can candidates expect for this role at The Dignify Solutions, LLC?
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