Business Analyst - Healthcare Claims & MMIS

Role: Business Analyst Healthcare Claims & MMIS

Location: Quincy, MA (Hybrid Onsite from Day 1)

Work Schedule: Monday Friday, 9:00 AM 5:00 PM

Candidate Requirement: Must be local to Quincy, MA, or the surrounding area.

Work Model: Hybrid from Day 1

Job Description

We are seeking an experienced Business Analyst (BA) to join a collaborative Medicaid Management Information System (MMIS) team. The ideal candidate must have strong experience in Healthcare Claims Processing, Provider Reimbursement, MMIS/Medicaid systems, or similar State Healthcare Programs.

The Business Analyst will support the development, testing, and implementation of projects and system enhancements related to provider reimbursement and healthcare claims processing.

The successful candidate should be well-versed in healthcare plan management, operational processes, business analysis, and the Software Development Life Cycle (SDLC). Preference will be given to candidates with Medicaid systems experience, healthcare claims processing expertise, and experience supporting state government healthcare programs.

The Business Analyst must possess a comprehensive understanding of healthcare business processes to ensure that development and testing activities align with system requirements, regulatory standards, and applicable federal and state laws.

This position involves active participation throughout the project lifecycle, including gap analysis, requirements gathering, solution design, development support, documentation, testing, implementation, and post-production stabilization.

The candidate must demonstrate excellent communication, analytical, documentation, and stakeholder management skills and be comfortable working independently and collaboratively with technical and business teams.

Mandatory Skills / Must-Have Qualifications

• Business Analysis: Strong experience gathering, analyzing, documenting, and validating business and functional requirements.
• Healthcare Claims & Payments: Hands-on experience with healthcare claims processing, provider reimbursement, HIPAA transactions, and payment workflows.
• SQL & Data Analysis: Strong SQL querying skills and experience performing data analysis, validation, and troubleshooting.
• MMIS / Medicaid: Experience with Medicaid Management Information Systems (MMIS), Medicaid programs, or comparable state healthcare systems.
• State Government Experience: Experience supporting state government healthcare projects or similar public-sector healthcare programs is highly desirable.
• Agile & SDLC: Knowledge of Agile methodologies and Software Development Life Cycle processes.
• QA / UAT Testing: Strong experience developing test strategies, test scenarios, test cases, executing tests, validating results, and obtaining testing sign-off.
• Communication & Documentation: Excellent communication skills and experience collaborating with business stakeholders, developers, QA teams, and vendors.
  
  

Key Responsibilities

• Lead and participate in Joint Application Design (JAD) sessions with business stakeholders, technical teams, and vendors.
• Gather, analyze, document, and validate business and functional requirements.
• Perform gap analysis and recommend solutions to align system functionality with business requirements.
• Support all phases of the SDLC, including requirements, design, development, testing, deployment, and stabilization.
• Develop comprehensive test strategies, test scenarios, and test cases based on documented business requirements.
• Execute and review testing activities, validate test results, document defects, and provide testing sign-off.
• Perform SQL queries and data analysis to support business requirements, troubleshooting, and system validation.
• Collaborate with vendors to ensure business requirements are accurately defined, implemented, and tested.
• Assist in creating end-user training materials, process documentation, and system user guides.
• Support post-implementation stabilization, including monitoring system changes, identifying issues, and coordinating corrective actions.
• Communicate project updates, system changes, and implementation impacts to relevant stakeholders.
• Participate in business meetings and represent the MMIS functional team as required.
• Provide functional support to program staff, vendors, and other stakeholders regarding healthcare claims and MMIS-related issues.
• Work closely with project managers, developers, system analysts, QA analysts, and business users to ensure successful project delivery.
• Provide backup support to other Business Analysts when necessary.
• Ensure solutions comply with HIPAA regulations and applicable federal and state healthcare requirements.
  
  

Preferred Qualifications

• Experience supporting Medicaid Management Information Systems (MMIS) or other state-sponsored healthcare programs.
• Strong understanding of healthcare claims processing, HIPAA claims transactions, provider reimbursement, and payment processing.
• Experience working with Medicaid claims adjudication systems and healthcare payer operations.
• Proficiency in SQL for data querying, validation, analysis, and reporting.
• Demonstrated expertise in business analysis throughout the entire project lifecycle.
• Experience with Agile project delivery and cross-functional collaboration.
• Strong QA/UAT experience, including requirements traceability and defect management.
• Excellent written and verbal communication skills.
• Ability to collaborate effectively with project managers, developers, business analysts, systems analysts, QA teams, and external vendors.
• Ability to work independently, prioritize tasks, and manage multiple assignments.
• Strong analytical and problem-solving skills, with the ability to document findings and recommend practical solutions.
  
  

Education & Experience

• Bachelor's degree or higher in Business Administration, Information Technology, Healthcare Administration, or a related field.
• Minimum 3 years of relevant experience in business analysis or an equivalent healthcare administration environment.
• Prior experience in healthcare claims, Medicaid/MMIS, or state government healthcare systems is strongly preferred.
  
  

Work Location & Requirements

• Location: Quincy, Massachusetts
• Work Arrangement: Hybrid from Day 1
• Local Candidates: Mandatory
• Working Hours: Monday through Friday, 9:00 AM to 5:00 PM
• Hybrid scheduling may change based on operational and business needs.