Business Analyst IV (Encounters Analyst)

TX-HHSC-DSHS-DFPS•Austin, TX

2d•$7,015 - $9,440•Hybrid

About The Position

The Texas Medicaid and CHIP Services (MCS) department is seeking a highly qualified Information Technology Business Analyst IV (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 advanced, senior-level business analysis work that supports the Texas Medicaid Enterprise Systems (MES). The position focuses on oversight, evaluation, and improvement of encounter and file submissions from Managed Care Organizations (MCO) and Dental Maintenance Organizations (DMO). The Encounters and File Support team manages technical and operational activities related to encounter submissions, ensuring that encounter data 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, works independently with minimal supervision, and excels at analyzing and resolving complex data sets, system, and operational issues. An employee at this level performs advanced business work, supports system maintenance and enhancements, and assists other analysts in identifying, analyzing, and resolving business issues and system issues.

Requirements

Five or more years of progressive responsibility 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 joint 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 advanced operational and data issues.
Skill in coordinating and facilitating meetings with stakeholders at varying technical levels.
Skill in translating business needs into clear requirements technical specifications.
Skill in preparing clear, concise documentation such as requirements, briefings, and recommendations.
Skill in reviewing complex project deliverables, system documentation, test plans, and technical documentation for accuracy, completeness, and alignment with business needs.
Skill in resolving data quality issues and developing actionable solutions.
Skill in tracking and documenting system issues, defects, risks, decisions, and action items through resolution.
Skill in developing training materials and presenting information clearly to system users and stakeholder groups.
Skill in using Microsoft Office tools: Excel for analysis, PowerPoint for briefings.
Ability to work independently with minimal supervision and considerable latitude for initiative while also collaboratively effectively in a team environment.
Ability to exercise sound judgment when making recommendations or decisions.
Ability to communicate effectively with technical and non-technical stakeholders.
Ability to monitor and evaluate encounter data quality, trends, and MCO/DMO performance.
Ability to recognize, analyze, and resolve advance data, system or operational problems.
Ability to interpret and apply policies, contract requirements, and regulations to encounter processing and system functionality.
Ability to provide business and technical assistance to analysts, vendors, contractors, system users, and other stakeholders by clarifying requirements, researching issues, troubleshooting problems, and supporting resolution of encounter processing and reporting issues.
Ability to develop, review, and validate business requirements, technical specifications, system documentation, and related project documents to ensure they accurately reflect business needs and system functionality to support encounter processing, system maintenance, or system enhancements.
Ability to develop Lean Business Cases for system enhancements, manage the project’s scope, acceptance, implementation, deployment, and post-implementation validation activities.
Ability to review test case scenarios to validate test results, identify defects, document issues, and confirm that system changes meet approved business requirements.
Ability to conduct post-implementation validation to confirm that system maintenance or enhancements were implemented as approved and are functioning as intended.
Ability to review complex project deliverables, including charters, design documentation, test plans, and provide comments and recommendations to document owners.
Ability to coordinate with outside vendors and contractors to complete projects and service requests, including defining, assigning, and evaluating their work.
Ability to develop training and conduct formal training sessions covering encounter processing.

Nice To Haves

Graduation from an accredited four-year college or university with major coursework in business, computer science, information systems, or a health-related field.
Five 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.
Leading SAFe® 6.0 Agilist certification or ability to obtain within one year.

Responsibilities

Leads the analysis of encounter data trends and anomalies to identify complex data issues, operational impacts, and opportunities for improvement.
Conducts research on operational challenges, including review of applicable rules, policies, contract requirements and regulations, to assess their impact on automated systems and system functionality.
Plans and facilitates workgroups and stakeholder meetings to resolve advanced issues and improve encounter processing and reporting outcomes.
Prepares executive-level briefings that summarize findings, impacts, risks, and recommended actions.
Provides production support by consulting on application analysis, troubleshooting system problems, coordinating issue resolution, and supporting implementation of effective solutions.
Represents the Encounters team on workgroups, meetings, and project initiatives with MCS, IT, MCOs, DMOs, TMHP, and other stakeholders.
Assesses program policies and procedures for their impact on encounter processing and data warehouse functions.
Gathers, develops, and documents, user requirements for system maintenance, enhancements, and service requests.
Prepares project deliverables, including Lean Business Cases (LBCs).
Participates in system development activities, including test case review, user acceptance testing, defect tracking, verification, implementation readiness, deployment support, and post-implementation validation.
Oversee 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.
Evaluates vendor performance and coordinates with vendors and contractors to complete projects, service requests, readiness reviews, and operational reviews.
Provides subject matter expertise, technical assistance, and quality assurance support for Medicaid and CHIP encounter processing and reporting initiatives.
Performs other assigned duties, including administrative support, training support, and oversight of projects, assignments, and special initiatives.