The application of municipal solid waste incineration tailings lightweight aggregate (MSWI-TLA) for reducing carbon emissions, energy consumption, and environmental pollution of bulk solid waste treatment has received extensive attention. As a new type of green lightweight aggregate, MSWI-TLA exhibits considerably good performance and broad prospects; however, its working performance in cement-based materials is not as good as that of ordinary aggregates. In this study, a standardized municipal solid waste incineration tailings lightweight fine aggregate (MSWI-TLFA) with a fineness modulus of 3.1 and a municipal solid waste of 10 mm were utilized as substitutes for the common aggregate. The incineration tailings lightweight coarse aggregate (MSWI-TLCA) with the particle size ranging from 5 to stirring process and the fluidity and filling properties were improved, and stratification was slowed down. Based on the slump, fluidity, and stratification data of municipal solid waste incineration tailings lightweight aggregate specific density concrete (MSWI-TLA-SDC), the internal and external stacking structure model, matrix density three-phase diagram, and stratification function relationship were established, and the formation mechanism of fluidity and homogeneity under the synergistic effect of MSWI-TLA-SDC matrix density was revealed. Simultaneously, the qualitative analysis of homogeneity was carried out intuitively and visualized using computed tomography (CT) technology, and the accurate quantitative analysis model of stratification degree and aggregate separation factor was established using the principle of fluid mechanics, and the optimization effect was verified. The results show that the fluidity of MSWI-TLA-SDC decreases by 3.3%–30.5% and the delamination degree increases by 4.9%–22.9% compared with ordinary concrete. The main reason for the poor fluidity and homogeneity of MSWI-TLA-SDC is the poor density synergy between tailings lightweight aggregate, ordinary aggregate, and mortar matrix. The preabsorbed gravel-type small-size tailings lightweight aggregate along with technical measures like combining water-reducing agent, fine tailings aggregate, and tailings powder can be used to reduce the difference in matrix density and fully exploit the synergistic effects of matrix density. For the closed-loop absorption of tailings lightweight aggregate as well as the technical advancement and promotion of MSWI-TLA-SDC, it is crucial to increase the fluidity and homogeneity of MSWI-TLA-SDC.