Business Analyst II (Medicaid Managed Care Encounter Analyst)

Texas Health & Human Services Commission•Austin, TX

2d•$5,099 - $6,702•Onsite

About The Position

The Texas Medicaid and CHIP Services (MCS) department is seeking a highly qualified Information Technology Business Analyst II (BA) to join the Encounters and File Support team. This position reports to the Manager of the Encounters and File Support unit within the Business Automation Support area. The work involves managing operational issues related to Medicaid encounters that are records of services delivered to Medicaid and CHIP beneficiaries enrolled in managed care plans and other vendor activities. The Business Analyst performs complex (journey-level) business analysis work to improve the quality of information technology solutions to meet the Medicaid business. The selected individual will perform technical analysis and provide guidance to other agency areas regarding the interpretation of policies and procedures in support of Medicaid Enterprise Systems (MES) functionality including, file support and coordination. The ideal candidate is a self-starter who exercises sound judgment, can work under general supervision, with moderate latitude for the use of initiative and independent judgement.

Requirements

Knowledge of Medicaid or CHIP programs and policies.
Knowledge of techniques used in automated systems.
Knowledge of customer relations principles and practices.
Knowledge of policies and procedures used in managed care, health care, health insurance programs, or health and human services programs.
Knowledge of relationships between agency systems as related to provider enrollment, client eligibility, and claims payment, including the multiple technologies supporting these complex systems.
Skill in coordinating and solving problems.
Skill in communicating effectively both verbally and in writing with technical and non-technical staff.
Skill in reviewing technical requirements to ensure vendors are using best practices and technology.
Skill in establishing and maintaining effective working relationships.
Skill in using personal computer application software such as Microsoft Office (Outlook, Teams, Word, Excel, PowerPoint). Advanced Excel, or similar programs.
Ability to ensure systems meet business user requirements.
Ability to research, evaluate and make recommendations for oversight issues.
Ability to gather and analyze information from a variety of sources, including written documentation, numerical data, reports, and other relevant sources, to identify trends, issues, and key findings, and to communicate effectively.
Ability to work cooperatively as a team member.
Bachelor’s degree from an accredited college or university combined with 3+ years of progressively responsible experience in technical leadership, project management, or account management.
At least seven years of relevant professional experience. The seven years must include at least three years of progressively responsible experience leading technical initiatives, managing projects, or managing customer relationships.
Experience in systems or business analysis.
Experience with health providers, managed care organizations, or external vendors.

Nice To Haves

Medicaid, CHIP, or Medicaid Managed Care policies
Medicaid claims or encounters
Agile methodologies or processes
Auditing or fiscal monitoring

Responsibilities

Monitor, assess, and manage data issues related to Medicaid encounters which are records of services delivered to Medicaid and CHIP beneficiaries enrolled in managed care plans.
Develop agendas, facilitate workgroup and stakeholder meetings.
Coordinate with team members to discuss encounter data and errors.
Prepare professional briefings to provide encounter status updates, identify issues and make recommendations.
Represent the Encounters unit as a liaison with other areas including Medicaid and CHIP programs, Managed Care Organizations (MCO), Texas Medicaid & Healthcare Partnership (TMHP), Information Technology, and other stakeholder groups.
Gather, develop, and document user requirements for the automation of new or improved existing systems to enhance business operations.
Monitor and analyze encounter submission errors to identify performance trends and recommend program improvements or contract enhancements.
Conduct detailed research and analysis of operational issues, including examining rules, policies, and regulations relating to timely and accurate encounter processing.
File support and coordination of operational files supporting Medicaid Enterprise Systems (MES) functionality.
Prepare diagrams and flow charts to assist in tracking system interface files.
Provide subject matter expertise and technical assistance for readiness reviews related to the Medicaid and CHIP encounter processing and reporting.
Ensure compliance to determine whether vendors can deliver services in accordance with the contract terms and requirements.
Communicate timely with the supervisor regarding challenging problems and provides recommendations to ensure appropriate action is taken.
Performs other duties as assigned by supervisor, including administrative functions and/or serving in a supporting capacity for the Medicaid/CHIP division.