Description

Federal Reporting & Compliance

• Analyze and interpret CMS, Medicaid, and state reporting requirements.
• Support T-MSIS, CMS-64, CMS-37, PERM, and other federal reporting initiatives.
• Ensure MMIS reporting processes comply with federal and state regulations.
• Monitor reporting changes and assess business and system impacts.

Business Analysis

• Gather, document, and manage business and functional requirements.
• Create BRDs, Functional Specifications, User Stories, and Process Flows.
• Conduct gap analyses and impact assessments for regulatory changes.
• Establish traceability between requirements, testing, and implementation.

Data Analysis & Validation

• Perform data validation, reconciliation, and quality assurance activities.
• Analyze claims, provider, member, encounter, and financial data.
• Identify data anomalies and work with technical teams to resolve issues.
• Validate report accuracy prior to submission.

Stakeholder Management

• Serve as the primary liaison between State Medicaid agencies, business users, reporting teams, and IT.
• Facilitate requirements workshops, reviews, and stakeholder meetings.
• Present reporting findings, risks, and recommendations to leadership.

Testing & Implementation Support

• Develop and execute test scenarios for reporting enhancements.
• Support SIT, UAT, regression testing, and production validation.
• Review defects, perform root cause analysis, and validate fixes.
• Support release planning and deployment activities.

Operational Support

• Support monthly, quarterly, and annual federal reporting cycles.
• Assist with audit requests and compliance reviews.
• Create operational procedures, SOPs, and reporting documentation.
• Support production issue analysis and resolution.

Required Qualifications

• Bachelor’s degree in business, Healthcare Administration, Information Systems, or related field.
• 5+ years of Business Analyst experience.
• 3+ years of MMIS or Medicaid experience.
• Strong knowledge of Medicaid claims, providers, members, financials, and encounters.
• Experience with federal reporting programs such as T-MSIS, CMS-64, CMS-37, or PERM.
• Experience creating BRDs, Functional Requirements, User Stories, and test cases.
• Strong SQL and data analysis skills.
• Experience working in Agile and/or Waterfall environments.

Preferred Qualifications

• MMIS modernization or O&M experience.
• Knowledge of healthcare EDI transactions (837, 835, 270/271, etc.).
• Experience with Cognos, Power BI, Tableau, or reporting tools.
• Experience supporting CMS audits and certification activities.
• CBAP or PMI-PBA certification preferred

Key Skills

Education

Bachelor's degree