Business Analyst IV (Encounters Analyst)
About the role
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).
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.
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.
Maintains oversight of 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.
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.
Qualifications
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 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.
Skills
Establishing and maintaining effective professional working relationships.
Analyzing, interpreting, and communicating advanced operational and data issues.
Coordinating and facilitating meetings with stakeholders at varying technical levels.
Translating business needs into clear requirements technical specifications.
Preparing clear, concise documentation such as requirements, briefings, and recommendations.
Reviewing complex project deliverables, system documentation, test plans, and technical documentation for accuracy, completeness, and alignment with business needs.
Resolving data quality issues and developing actionable solutions.
Tracking and documenting system issues, defects, risks, decisions, and action items through resolution.
Developing training materials and presenting information clearly to system users and stakeholder groups.
Using Microsoft Office tools: Excel for analysis, PowerPoint for briefings.
Benefits
Comprehensive benefits package including 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more.
Pay
$7,015.16 - $9,439.83 per month
Schedule
Day shift