Role & seniority: Senior/Lead Medicaid Business SME with hands-on Testing Manager experience

Stack/tools: Medicaid systems; CMS regulations and federal/state guidance; testing lifecycle (test planning, case development, execution, defect management, reporting); documentation artifacts (Trading Partner Plans, System Integration Plans, Quality/Performance Testing Plans, Companion Guides, Test Summary Reports); data analysis for rule validation; stakeholder facilitation and UAT coordination

Top 3 responsibilities

Lead end-to-end testing activities (manual and automated), including planning, case development, execution, defect management, and reporting
Analyze and document Medicaid business processes (provider enrollment, eligibility, claims, prior authorization, encounters, reporting) and ensure regulatory/compliance alignment
Collaborate with policy, operations, compliance, IT, and data teams; coordinate requirements sessions and UAT across releases; provide regular testing reports and risk assessments

Must-have skills

10+ years IT systems analysis experience in healthcare/Medicaid
SME in Medicaid processes, systems, and regulations; strong documentation and communication
Experience as Testing Manager overseeing large-scale testing; requirements gathering and process analysis

Nice-to-haves

Experience with government contractors
Location & work type: Hybrid role; 3 days per week in office

Full Description

Hybrid: 3 days work from office

Job Summary

We are looking for a Medicaid Business Subject Matter Expert (SME) with strong hands-on experience as a Testing Manager. The ideal candidate will have deep expertise in Medicaid systems and business processes, with proven experience in leading and managing large-scale testing activities. Strong documentation and communication skills are also required.

Key Responsibilities

Analyze and document Medicaid business processes (provider enrollment, eligibility, claims, prior authorization, encounters, reporting).
Interpret and apply CMS regulations, Medicaid state plan requirements, and federal guidance to ensure system compliance and operational accuracy.
Collaborate with development, data, and project teams to design, validate, and test system components and workflows.
Lead end-to-end testing activities, including test planning, test case development, test execution, defect management, and reporting for both manual and automated testing efforts.

Develop and maintain detailed documentation, including

Trading Partner Testing Plans
System Integration Plans
Quality Management Plans
Performance Testing Plans
Companion Guides
Test Summary Reports and Results
Conduct and facilitate requirements and testing sessions with stakeholders across policy,
operations, compliance, and IT teams.
Coordinate and support User Acceptance Testing (UAT) to ensure successful validation of Medicaid system functionality across releases.
Leverage data analysis to validate business rules, identify anomalies, and support decision-making.
Provide regular testing reports, issue summaries, and risk assessments to project leadership.
Perform other related duties as assigned.

Required Qualifications

10+ years of IT systems analysis, with a focus on healthcare systems and Medicaid processes.
Subject matter expertise in Medicaid business processes, systems, and regulations.
Experience as a Testing Manager overseeing large-scale testing efforts.
Strong documentation and communication skills.

Required Education

Bachelor’s degree in business administration or science or a related field.

Required Experience

Over 10 years of experience in IT systems analysis, with a strong emphasis on healthcare systems and Medicaid processes.

Test Manager