Senior Systems/Research Analyst

State of Oklahoma•Oklahoma City, OK

3d•Onsite

About The Position

The purpose of this position is to support the integrity and effective operation of the Medicaid Management Information System (MMIS) by maintaining and monitoring reference file subsystems and ensuring alignment with OHCA policy as well as state and federal Medicaid regulations. This role analyzes healthcare coding structures and payment rules, evaluates system impacts of policy and regulatory changes, and collaborates with medical, policy, finance, provider engagement, and claims units to ensure accurate claims processing and program compliance. The position also conducts research, performs operational and utilization analysis, supports system modifications and special projects, and provides guidance and training to internal staff and external partners to promote consistent interpretation and implementation of Medicaid program policies.

Requirements

This position requires knowledge of Medicaid program operations, healthcare claims processing, and medical coding systems including ICD, CPT, HCPCS, and revenue codes, as well as an understanding of state and federal healthcare regulations that govern Medicaid reimbursement.
The role requires strong analytical skills to monitor and maintain system reference files, evaluate claims payment logic, interpret policy requirements, and identify operational or compliance issues within the MMIS environment.
The ability to research regulations, analyze system impacts, coordinate with internal units and external partners, and communicate complex policy or system changes clearly to stakeholders is essential.
Success in this role also requires strong organizational skills, attention to detail, and the ability to manage multiple analytical tasks and projects while supporting program integrity and operational improvements.
Key Korn Ferry competencies aligned with this work include Manages Complexity, Collaborates, and Ensures Accountability, reflecting the need to navigate regulatory requirements, work effectively across technical and policy teams, and maintain accurate, compliant system operations.
To be considered for this position your application must include a resume/CV with complete work and education history.
Bachelor’s degree in public health, health information management or closely related field and two years of professional experience in healthcare data analytics, healthcare information systems, and/or healthcare program operations OR An equivalent combination of education and experience.

Nice To Haves

Experience in health care procedures, medical coding, or medical claim payments and processing
Medicaid policy interpretation or program compliance experience
Healthcare data analysis, reporting or utilization review

Responsibilities

Maintains the OHCA OKMMIS reference file subsystem which includes: ICD-/CM and PCS diagnosis and surgical procedure codes, CPT, revenue and HCPCS, etc. files. Ensures that all files reflect appropriate rules included in OHCA policy as well as appropriate state and federal policies.
Using multiple methods of oversight monitors the integrity of the reference file (e.g., report generation and review of associated documentation). Researches and investigates special areas of concern.
Works with OHCA Medical Professional, Finance and Policy units to reviews law and regulations and makes recommendations for changes to the Medicaid program.
Interfaces with OCHA staff regarding OKMMIS issues, changes, problems or updates.
Conducts frequent evaluations of OKMMIS issues and provides problem solving assistance to ensure that the payment mechanisms of OHCA comply with OHCA policy and all state and federal regulations.
Interfaces with OHCA Provider Engagement and Claims Adjudication Unit. Interpret policy and assist in problem solving. Provides training concerning new and changing programs. Researches and investigates special areas of concern.
Reviews law and regulations and makes recommendations for changes to the Medicaid program.
Performs a variety of routine analytical tasks and special projects related to operational and utilization performance and/or analysis for the Medicaid program.
Coordinates in the completion of special projects/studies including report generation, review and detailed recommendations. Coordinate with agency staff and fiscal agent staff to assure appropriate outcomes are met, by monitoring inter-agency information system changes and modifications for project development, implementation and deadlines.
Provides training assistance to other agencies, providers, clients and agency staff, with interpretation of existing policies, development of new policies, and claims processing issues.
Represents OHCA at meetings, trainings, task forces, or conferences.
Other duties as assigned.