As a Business Analyst - Healthcare Reference at Gainwell, you will contribute to healthcare technology delivery by analyzing business needs, documenting requirements, and supporting solutions involving healthcare reference code sets and claims data. You will act as a bridge between business stakeholders, coding/policy experts, and technical teams to translate operational needs into clear and actionable requirements. This role is strictly involved in business analysis, requirements documentation, and healthcare reference data support activities and does not involve direct access to Protected Health Information (PHI), Personally Identifiable Information (PII), or any secured or confidential client data. The work is limited to analysis of healthcare claims, reference code sets, and system configurations using governed datasets and does not include handling or processing of sensitive health or personal information
• Analyze, design, and document business requirements related to healthcare claims, reference data, and code sets
• Work with stakeholders to gather and define requirements involving ICD, CPT, HCPCS, UB‑04, revenue codes, provider taxonomy, and other healthcare reference data
• Develop and maintain business analysis artifacts such as BRDs, functional specifications, process flows, decision tables, and traceability matrices
• Translate business, policy, and coding requirements into clear functional objectives for technical teams
• Perform impact analysis for code‑set changes, regulatory updates, and policy changes across claims processing systems
• Support testing activities, including defining test scenarios and validating system outputs
• Participate in technical reviews and project discussions to ensure requirement alignment across lifecycle phases
• Identify opportunities for business process improvement and data governance enhancements
• Collaborate with developers, testers, and stakeholders for issue resolution, defect triage, and root‑cause analysis
• Communicate effectively with business and technical teams through documentation, meetings, and presentations
Preferred Skills:
• Experience with MMIS systems or healthcare program implementations
• Knowledge of HIPAA transactions and X12 claims (837, 835, etc.)
• Experience with SQL for data analysis and validation
• Familiarity with ALM tools, Jira, ServiceNow, or similar platforms
• Experience with data governance, reference‑data management, or claims edits/billing rules
• Exposure to regulatory compliance and healthcare audits
• Business analysis certifications or healthcare coding knowledge
Remote work environment with shift time (2 pm -11pm IST)
For 50 years, our nation’s federal Medicaid program has worked to improve the health, safety and well-being of America’s most vulnerable populations: low-income families, women and children, seniors, and those with disabilities. With positive health and cost outcomes that pierce inequities and impact economies, the success of these programs is inextricably tied to the prosperity of communities, individual states and the nation as a whole. We think that demands respect and, more importantly, is deserving of a lifetime commitment from innovators who can help those who operate within and around health and human services evolve — in any market at any stage. At Gainwell Technologies, that’s our sole focus.
Built across more than five decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet agencies, health plans and MCOs where they are on their modernization journeys and propel them into the future of public health. Our commitment to innovation, deep experience and ability to leverage insights from customers across 50 states has allowed us to expand on next-generation, cloud-enabled technologies.
Today, Gainwell offers one of the most comprehensive suites of scalable services and solutions on the market — all proven to deliver cost savings, better patient outcomes and an improved provider experience. Equally important to our expanding technologies and results: We bring ideas that bring policies to life.
