Functional Consultant

Required Skills/ Qualifications

• Experience as a Functional Analyst, Business Analyst, or Consultant within healthcare, Medicaid, or government-sponsored programs.
• Excellent stakeholder management and communication skills with the ability to collaborate effectively with State agencies, Managed Care Organizations (MCOs), and third-party vendors.
• Strong understanding of Medicaid operations, LTSS programs, member enrollment processes, and managed care environments.
• Practical experience working with HIPAA 834 and/or 278 transaction sets, including transaction structures, loops, segments, code values, and implementation guides.
• Experience creating business and functional requirements documents (BRDs/FRDs), workflow diagrams, data mapping specifications, and interface documentation.
• Proven experience supporting development and testing teams through requirements clarification, UAT, issue resolution, and defect management.
• Proficiency with project and documentation tools such as JIRA, Confluence, Visio, and Microsoft Office Suite.
• Experience supporting both HIPAA 834 Enrollment and HIPAA 278 Authorization transactions.
• Familiarity with Managed Long-Term Care (MLTC) enrollment workflows and non-MAGI eligibility processes.
• Working knowledge of SQL and data analysis techniques for reconciliation, validation, and root-cause investigation.