Advisor Technical Business Analyst - Medicaid FHIR Architecture & Interoperability

Summary

As an Advisor Technical Business Analyst - Medicaid FHIR Architecture & Interoperability at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.

Gainwell Technologies is seeking a Technical Business Analyst with deep Medicaid experience and strong FHIR architecture expertise to support large‑scale Medicaid modernization and interoperability initiatives. This role sits at the intersection of state Medicaid policy, enterprise architecture, and modern data exchange standards and plays a key part in translating complex Medicaid data and workflows into scalable, FHIR‑based solutions.

The ideal candidate has hands‑on experience with Provider+, FHIR architecture, profiling, and data translation, and can operate as a trusted advisor to architects, engineers, and state clients—ensuring interoperability solutions are compliant, sustainable, and aligned to CMS and Gainwell standards.

Your role in our mission

Medicaid & Interoperability Architecture

• Serve as a FHIR‑focused technical business analyst supporting Gainwell’s Medicaid interoperability and data exchange solutions.
• Translate state Medicaid business requirements, CMS mandates, and client‑specific policies into FHIR‑aligned technical requirements.
• Support architecture decisions related to FHIR‑based integration patterns, including APIs, canonical data models, and transformation strategies.
• Partner with solution architects to ensure interoperability designs are scalable, reusable, and consistent with Gainwell enterprise standards

Stakeholder & Client Engagement

• Serve as a technical translator between Medicaid business stakeholders, state agencies, and engineering teams.
• Clearly explain FHIR architecture and interoperability concepts to non‑technical audiences.
• Support governance reviews, standards compliance, and documentation required by state Medicaid programs and CMS

FHIR Standards & Data Translation

• Lead analysis and documentation for mapping Medicaid data to and from FHIR (R4), including:
  • • MMIS data models ↔ FHIR
    • X12 (270/271, 834, 837, 835) ↔ FHIR
    • HL7 v2 ↔ FHIR
• Define and maintain FHIR profiles, extensions, value sets, and implementation guidance appropriate for Medicaid use cases.
• Support FHIR API design by reviewing resource structures, payloads, search parameters, and business rules.
• Ensure FHIR implementations align with:
  • • CMS Interoperability and Prior Authorization rules
    • Patient Access and Provider Directory API requirements
    • Gainwell reusable integration assets and patterns

Technical Analysis & Delivery Support

1. Produce clear, detailed technical artifacts, including:
   1. FHIR data mapping documents
   2. API and integration use cases
   3. Sequence diagrams and process flows
   4. Acceptance criteria and validation rules
2. Actively collaborate with:
   1. Integration and platform engineers
   2. Enterprise and solution architects
   3. State Medicaid SMEs and external vendors
3. Review and validate transformation logic, schemas, and API contracts.
4. Support SIT and UAT by validating data accuracy, business compliance, and end‑to‑end interoperability.

What we're looking for

• Nine or more years of experience working as a business analyst or ‘requirements translator’ between technical and non-technical personnel, with 3 or more years of Medicaid and Medicare experience preferred
• Knowledge of Microsoft Excel advanced features such as macros and/or relational database software
• Ability to clearly and concisely translate technical requirements to a non-technical audience 
• Skills working with business processes and re-engineering
• Curiosity to solve complex problems and strong interpersonal skills to interact with and influence clients and team members
• A caring team leader who motivates and coaches less experienced resources

Preferred Qualifications

• Familiarity with Gainwell’s Provider+ Product data and system design
• Experience supporting CMS interoperability initiatives (Patient Access API, Provider Directory API, PA API)
• Familiarity with integration platforms and tools:
  • Postman, Swagger/OpenAPI
  • Interface engines (Mirth, Rhapsody)
  • Cloud‑based integration services
• Experience working on Medicaid transformation or modular MMIS modernization projects
• Agile or hybrid SDLC experience in large enterprise environments

Key Skills & Attributes

• Strong systems thinking and architectural mindset
• Able to balance policy, data, and technology considerations
• Excellent written and verbal communication
• High attention to detail and regulatory compliance
• Comfortable influencing without authority across teams

What you should expect in this role

• Fully remote options from most US locations and territories
• Video cameras must be used during all interviews, as well as during the initial week of orientation
• Photo will be taken during screening for verification in all steps of the recruitment process.

• This posting is intended for pipelining. This is a developing position therefore the job description is subject to change.

• #LI-HC!

  Please ensure you join all screenings, interviews and meetings from a quiet location with a stable internet connection. 

  Video is required for screenings and interviews, so please test your camera and microphone in advance.

  Do not use AI tools, virtual backgrounds/filters, or visual enhancements during the interview.

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