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Texas Health and Human Services · 8 hours ago

Business Analyst III (Encounter Analyst)

Austin, TX

Full-time

Hybrid

Mid, Senior Level

$5,797.66/mo - $9,508.25/mo

3+ years exp

Texas Health and Human Services is seeking a highly qualified Information Technology Business Analyst III to join their Encounters and File Support team. The role involves overseeing the processing of encounter submissions, analyzing data trends, and ensuring compliance with state and federal standards.

Health Care

No H1B

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

Qualification

Business analysisMedicaidCHIP ServicesData quality analysisAgile methodologiesContract performance monitoringHealthcare industry knowledgeStakeholder engagementMicrosoft Office proficiencyTechnical requirements reviewUser requirements developmentResearch skillsJudgmentEffective communicationTeam collaborationProblem-solvingDocumentation skillsDecision-making

Required

Three 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 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

Leading SAFe® 6.0 Agilist certification or ability to obtain within one year

Preferred

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