Senior Business Analyst - Medicaid Provider Enrollment Modernization

United StatesRemoteFull-timesenior

Business AnalystData & AI

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Quick Summary

Overview

This position is listed on behalf of a partner company, who manages all applications and next steps.

Technical Tools

Business AnalystData & AI

This role supports a major Medicaid provider enrollment modernization initiative focused on improving digital experiences, workflows, integrations, and data quality. You’ll work closely with state program representatives, business and operations teams, technical stakeholders, and third-party vendors to transform complex requirements into practical technology solutions. The position spans provider-facing portals, workflow automation, MMIS integrations, identity management, data exchanges, and enrollment operations. You’ll play a central role in connecting policy and operational needs with development, testing, and implementation teams. The environment is highly collaborative and Agile, with multiple stakeholders and interconnected systems. This is an opportunity for an experienced Business Analyst to make a measurable impact on public-sector healthcare technology and provider enrollment processes.

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

~2 min read

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.