Note: The job is a remote job and is open to candidates in USA. The Dignify Solutions, LLC is seeking a highly experienced Medicaid Eligibility & Enrollment Business Analyst/SME with over 15 years of experience in supporting large-scale Medicaid programs. This role will focus on Medicaid modernization initiatives, eligibility operations, system enhancements, and stakeholder coordination across business and IT teams.
Responsibilities
- Analyze Medicaid eligibility and enrollment business processes, workflows, and system functionality
- Interpret federal and state Medicaid policies and translate requirements into functional specifications
- Support eligibility determination processes for programs including MAGI, Non-MAGI, CHIP, SNAP integration, and related public assistance programs
- Work closely with operations teams, system integrators, and development teams to resolve eligibility and enrollment issues
- Perform root cause analysis for eligibility defects, enrollment discrepancies, and data inconsistencies
- Develop business requirements documents (BRDs), functional specifications, user stories, and process flows
- Support UAT, SIT, regression testing, and production validation activities
- Assist with data analysis, reconciliation, and reporting related to eligibility and enrollment transactions
- Coordinate with state agencies, vendors, and business stakeholders on system enhancements and operational initiatives
- Provide production support and guidance during critical implementation and renewal periods
- Participate in policy workshops, backlog grooming sessions, and operational review meetings
- Mentor junior analysts and provide subject matter expertise to project teams
Skills
- 15+ years of experience in Medicaid eligibility and enrollment systems and operations
- Strong understanding of Medicaid eligibility rules, enrollment lifecycle, renewals, Stacking, notices, and case management processes
- Mandatory experience working with large system integrators, healthcare vendors, or state Medicaid programs
- Experience working on large state Medicaid programs and integrated eligibility systems
- Experience supporting Medicaid modernization or eligibility transformation initiatives
- Strong analytical, problem-solving, and communication skills
- Experience working with business and technical teams in Agile and/or Waterfall environments
- Ability to analyze large datasets and identify operational or system issues
- Experience with defect triage, production support, and operational stabilization activities
- Experience with platforms such as Pega, Curam, Salesforce, or other eligibility systems
- Knowledge of CMS, ACA, MAGI, and state Medicaid compliance requirements
- Familiarity with healthcare interoperability and data exchange processes
- Experience supporting call center operations, renewals, and eligibility reconciliation efforts
- SQL or PowerBI experience required
Company Overview