Medicaid -MCO- Business Analyst

Dice is the leading career destination for tech experts at every stage of their careers. Our client, Headway Tek Inc, is seeking the following. Apply via Dice today! Contract to Hire role Remote USA JC: In Process Rate: $35/Hr on W2 with out benefits Business Analyst Job Description - Medicaid Membership (MCO Experience Required) Key Responsibilities • Act as the liaison between MCO business operations, IT teams and state agencies. • Interact with Clients. Prepare a roadmap for Implementation of Software. Contribute in design related discussions • Gather, analyze, and document business requirements related to Medicaid membership management, eligibility, enrollment, premium billing, and reconciliation. • Support compliance with state and federal Medicaid regulations, ensuring system functionality meets CMS and state-specific rules. • Translate business needs into functional requirements, use cases, and user stories for membership systems and portals. • Partner with operations teams to monitor, automate and improve member onboarding, disenrollment, and work requirement compliance workflows. • Work with integration teams on data exchanges with state Medicaid agencies (eligibility files, roster updates, Work requirement compliance reporting). • Develop test cases, perform UAT (User Acceptance Testing), and validate system enhancements before production releases. • Provide business analysis for operational reports, dashboards, and performance metrics. • Collaborate with cross-functional teams (call center, claims, care management) to ensure membership data accuracy and timely resolution of issues. • Support audits and reporting requirements by maintaining clear documentation and traceability of business rules. • Contribute to RFI/RFP responses Required Skills & Experience • Minimum 5+ years working at an MCO or Medicaid-focused environment in business operations and systems. • Experience supporting or implementing Medicaid membership SaaS or hosted platforms. • Good understanding of MCO operations and systems around Medicaid, MLTC, CHIP, DSNP lines of businesses • Familiarity with work requirement tracking, exemptions, and compliance reporting. • Strong understanding of Medicaid membership lifecycle: eligibility, enrollment, disenrollment, premium billing, reconciliation, and reporting. • Familiarity with state Medicaid agency interactions (834/820 transactions, roster management, state audits, compliance reporting). • Experience with regulatory compliance and CMS/state Medicaid rules (including work requirements). • Hands-on experience with Medicaid membership systems, portals, or core admin platforms. • Proficiency in business requirements gathering, process mapping, and writing functional specifications. • Strong knowledge of data flows, integration methods, and file/API exchanges between MCOs and state agencies. • Analytical skills to perform gap analysis, root cause analysis, and recommend operational improvements. • Excellent documentation skills (BRD, FSD, user stories, workflows, SOPs). • Communication skills to effectively engage with business users, IT teams, and external regulators. • Knowledge of healthcare data standards (HIPAA, 834, 820, HL7, FHIR) would be a plus. • Background in process automation, analytics, or dashboarding for Medicaid membership