Title: Business Analyst – Claims / Benefits (Medicaid MMIS)
Job Summary:
We are seeking an experienced Business Analyst with strong Medicaid/MMIS expertise to support adult long-term care provider enrollment systems and related healthcare operations for a State of Wisconsin project. The ideal candidate will have hands-on experience with Medicaid systems, data analysis, policy support, and cross-functional coordination in a complex healthcare environment.
Key Responsibilities:
- Serve as the primary point of contact for assigned systems and operational projects.
- Support operational administration of the adult long-term care (LTC) provider enrollment system.
- Lead project lifecycle activities including requirements gathering, design reviews, UAT coordination, and production validation.
- Analyze and troubleshoot system issues, data inconsistencies, and operational defects.
- Work closely with vendors, stakeholders, and internal teams to resolve technical and business process issues.
- Perform data extraction and analysis using SAS, Tableau, Excel, and related tools.
- Analyze healthcare policies, Medicaid regulations, HIPAA compliance standards, and operational procedures.
- Develop reports, charts, dashboards, and presentation materials for leadership and stakeholders.
- Conduct trend analysis and provide recommendations for system and process improvements.
- Collaborate with public/private agencies and healthcare providers on system enhancement initiatives.
Required Skills & Experience:
- 3+ years of Business Analyst experience supporting Medicaid/MMIS or similar healthcare systems.
- Strong understanding of Medicaid MMIS systems and healthcare operations.
- Experience with SDLC, business requirements gathering, testing, and system implementation.
- Hands-on experience with:
- interChange
- OnBase
- EDW/DAR (SAS)
- CARES
- Strong data analysis and reporting experience using Excel, SAS, Tableau, or similar tools.
- Knowledge of HIPAA regulations and healthcare data standards.
- Experience analyzing large datasets and interpreting statistical results.
- Excellent communication, collaboration, documentation, and presentation skills.
- Ability to work independently in a matrixed environment.
- Experience in one or more areas:
- Provider Management
- Eligibility & Enrollment
- Claims & Encounters
- Benefit Plans
Preferred Qualifications:
- Certified Business Analysis Professional (CBAP/CABP) preferred.
- Experience supporting Wisconsin state healthcare programs.
- Knowledge of Wisconsin Adult Long-Term Care Programs.
- Strong organizational and time management skills.
