Business Analyst IV (Encounters & File Support)

Texas Health & Human Services Commission•Austin, TX

23h•$7,015 - $11,865•Onsite

About The Position

The Texas Health and Human Services Commission’s Medicaid and CHIP Services department is hiring a senior-level Information Technology Business Analyst IV for 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 supports the Texas Medicaid Enterprise Systems (MES) through advanced business analysis, system maintenance, and enhancement work. The role focuses on oversight, evaluation, and improvement of encounter and file submissions from Managed Care Organizations (MCOs) and Dental Maintenance Organizations (DMOs). The team’s technical and operational work ensures encounter data is complete, timely, and compliant with state and federal requirements. This work supports contract oversight, actuarial rate setting, program monitoring, and federal reporting. The successful candidate will independently analyze and resolve complex data, system, and operational issues, support system changes, and assist other analysts. The position is based at the Austin office and requires the selected candidate to work onsite. Some travel, including occasional overnight trips, may be needed; travel is listed as up to 20%.

Requirements

Five or more years of progressive responsibility in 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 joint interface files, end-to-end system processing, and techniques for accurate and reliable automated data processing.
Knowledge of managed care, health care, or the 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 and technical specifications.
Skill in preparing clear, concise documentation such as requirements, briefings, and recommendations.
Skill in reviewing 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 using Microsoft Office tools, including Excel for analysis and PowerPoint for briefings.
Ability to work independently with minimal supervision and considerable latitude for initiative, while also working collaboratively 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 advanced 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 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.
Ability to develop Lean Business Cases for system enhancements and manage project scope, acceptance, implementation, deployment, and post-implementation validation activities.
Ability to review test case scenarios, validate test results, identify and document defects, and confirm system changes meet approved business requirements.
Ability to conduct post-implementation validation to confirm system changes were implemented as approved and function as intended.
Ability to review complex project deliverables, including charters, design documentation, and test plans, and provide comments and recommendations.
Ability to coordinate with outside vendors and contractors to complete projects and service requests, including defining, assigning, and evaluating their work.

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.
Five years of 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

Lead analysis of encounter data trends and anomalies to identify complex data issues, operational impacts, and opportunities for improvement.
Research operational challenges and assess how rules, policies, contract requirements, and regulations affect automated systems and functionality.
Plan and facilitate workgroups and stakeholder meetings to resolve advanced issues and improve encounter processing and reporting.
Prepare executive-level briefings summarizing findings, impacts, risks, and recommended actions.
Provide production support by consulting on application analysis, troubleshooting system problems, coordinating issue resolution, and supporting effective solutions.
Represent the Encounters team in workgroups, meetings, and project initiatives with MCS, IT, MCOs, DMOs, TMHP, and other stakeholders.
Assess program policies and procedures for their impact on encounter processing and data warehouse functions.
Gather, develop, and document user requirements for system maintenance, enhancements, and service requests.
Prepare project deliverables, including Lean Business Cases (LBCs).
Participate in system development activities, including test case review, user acceptance testing, defect tracking, verification, implementation readiness, deployment support, and post-implementation validation.
Oversee assigned MCO and DMO encounter submissions and ensure data accuracy and quality through HIPAA and business validation rules.
Monitor MCO and DMO performance for submission timeliness, completeness, and compliance with state and federal standards.
Evaluate vendor performance and coordinate with vendors and contractors on projects, service requests, readiness reviews, and operational reviews.
Provide subject matter expertise, technical assistance, and quality assurance support for Medicaid and CHIP encounter processing and reporting initiatives.
Perform other assigned duties, including administrative and training support and oversight of projects, assignments, and special initiatives.
Develop training materials and conduct formal training sessions covering encounter processing.