Job Description
Note: The job is a remote job and is open to candidates in USA. Conflux Systems Inc is seeking a Business Analyst with a focus on Medicaid Membership. The role requires expertise in Medicaid operations and systems, particularly in MCO environments, to support and implement membership-related platforms and ensure compliance with regulatory standards. Responsibilities • 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. • Knowledge of healthcare data standards (HIPAA, 834, 820, HL7, FHIR) would be a plus. Skills • 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. • Knowledge of healthcare data standards (HIPAA, 834, 820, HL7, FHIR) would be a plus. Company Overview • Welcome to Jobs via Dice, the go-to destination for discovering the tech jobs you want. It was founded in undefined, and is headquartered in , with a workforce of 0-1 employees. Its website is Apply tot his job