Job Description

Job Description

Job Title: Techno-functional analyst

Location- Lexington, KY (Onsite)

Duration: Full-time with Apexon

Description (Medicare / Integrated Eligibility):

• Responsible for supporting the daily maintenance, operations, and continuous enhancements of the Integrated Eligibility and Enrollment system, with a focus on Medicare-related eligibility, coordination of benefits, and interfaces with Medicaid programs. Monitor and analyze system data to ensure compliance with CMS regulations, Medicare program rules, and state/federal policies.
• Collaborate closely with business stakeholders, Medicare policy teams, and technical teams to design and implement system enhancements, regulatory updates, and policy-driven changes. Ensure accurate and timely eligibility determinations, benefit coordination, and enrollment processing across Medicare and Medicaid programs.
• Provide analysis and support for eligibility logic, system behavior, and data flows, and clearly communicate complex system functionality and eligibility outcomes to non-technical users and program staff.

Nice to Have:

• Hands-on knowledge of Integrated Eligibility systems , particularly the eligibility determination rules and workflows, is highly desirable.
• As discussed, a knowledge of Integrated Eligibility, specifically the Eligibility determination part, would be a super nice to have. But strong SQL skills are a must.

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