Business Analyst III (Encounter Analyst)

Texas Health & Human Services Commission•Austin, TX

3d•$5,798 - $9,508•Hybrid

About The Position

The Texas Medicaid and CHIP Services (MCS) department is seeking a highly qualified Information Technology Business Analyst III (BA) to join the Encounters and File Support team within the MCS Business Automation Support unit. The position reports to the Manager of Encounters and File Support and performs highly complex (senior-level) business analysis activities that support the Texas Medicaid Enterprise Systems (MES), with a primary focus on oversight, evaluation, and improvement of encounter and file submissions from Managed Care Organizations (MCOs) and Dental Maintenance Organizations (DMOs). The Encounters and File Support team manages all technical activities related to encounter submissions, ensuring that encounter data received from MCOs and DMOs is complete, timely, and compliant with state and federal submission requirements. This work supports contract oversight, actuarial rate setting, program monitoring, and federal reporting. The ideal candidate is a self-starter who exercises sound judgment, can work independently with limited supervision, and excels at solving complex data and operational problems.

Requirements

Three or more years of progressive experience in the areas of leading technical initiatives, business analysis, or project management.
Documented experience as a business analyst or systems analyst, including requirements gathering, issue analysis, or data evaluation.
Experience researching and interpreting policies, operational rules, or technical documentation.
Knowledge of Texas Medicaid and CHIP Services programs.
Knowledge of automated systems concepts and methodologies, including managing interface files, understanding end-to-end system processing, and techniques for ensuring accurate and reliable automated data processing.
Knowledge of Managed care, health care or health insurance industry.
Knowledge of Health and human services programs and policies.
Knowledge of Agile or iterative development methodologies.
Knowledge of Contract performance monitoring and compliance requirements.
Skill in establishing and maintaining effective professional working relationships.
Skill in analyzing, interpreting, and communicating complex operational and data issues.
Skill in coordinating and facilitating meetings with stakeholders at varying technical levels.
Skill in preparing clear, concise documentation such as requirements, briefings, and recommendations.
Skill in reviewing technical requirements and collaborating effectively with product owners and vendor teams.
Skill in identifying data quality issues and developing actionable solutions.
Skill in using Microsoft Office tools: Excel for analysis, PowerPoint for briefings.
Ability to monitor and evaluate encounter data quality, trends, and MCO/DMO performance.
Ability to recognize, analyze, and resolve complex data or operational problems.
Ability to work both independently and collaboratively in a team environment.
Ability to develop and document user requirements that support system enhancements.
Ability to interpret and apply policies, contract requirements, and regulations.
Ability to exercise sound judgment when making recommendations or decisions.
Ability to communicate effectively with technical and non-technical stakeholders.

Nice To Haves

Leading SAFe® 6.0 Agilist certification
Graduation from an accredited four-year college or university with major coursework in business, computer science, information systems, or a health-related field.
Three years’ experience working with healthcare providers, MCOs, DMOs, or external vendors.
Experience working with Medicaid and CHIP Services programs, particularly managed care.
Experience processing Medicaid claims, encounters or healthcare data analytics.
Experience using Agile methodologies and participating in software development lifecycle activities such as testing or acceptance criteria.
Experience with contract monitoring, auditing or financial monitoring.
Knowledge of relationships between agency systems related to provider enrollment, client eligibility, claims payment, and data warehouse processes.

Responsibilities

Oversees the processing of assigned MCO and DMO encounter submissions. Ensures the accuracy and quality of encounter data through HIPAA and business validation rules. Monitors MCO/DMO performance related to submission timeliness, completeness, and compliance with federal and state standards.
Leads the analysis of encounter data trends and anomalies. Plans and facilitate workgroup and stakeholder meetings to resolve data issues and improve reporting outcomes. Conducts research on operational challenges, including review of applicable rules, policies, and regulations. Prepares executive-level briefings that summarize findings, risks, and recommended actions.
Represents the Encounters team on workgroups, meetings, and project initiatives with MCS, IT, MCOs, DMOs, and TMHP. Assesses program policies and procedures for their impact on encounter processing and data warehouse functions. Gathers, develops, and documents user requirements for system enhancements and automation. Prepares project deliverables, including Lean Business Cases (LBCs). Participates in development activities such as testing, verification, and approval of new system implementations, and provides quality assurance support for complex projects.
Evaluates vendor performance for compliance and service readiness. Provides subject matter expertise and technical assistance during readiness and operational reviews of Medicaid and CHIP encounter processing and reporting.
Performs other assigned duties, including administrative support and oversight of projects, assignments, and special initiatives.