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Health & Human Services Comm

Business Analyst IV (Claims Support Services)

Health & Human Services Comm, Austin, Texas, us, 78716


Job Description:The Texas Health and Human Services Commission (HHSC) Medicaid and CHIP Services (MCS) department seeks a qualified candidate to fill the position of Business Analyst (BA) IV in the Claims Support Services unit.

This position reports to the Director of Claims Services within the Claims Management Division (CMD). The BA will serve as a Senior Product Owner and perform advanced (senior level) business analysis work on complex program initiatives supporting Long Term Care (LTC) forms processing, service authorizations and claims.

The ideal candidate will lead initiatives that cross multiple program areas, teams, and vendors. The position oversees the work products completed by other resources performing business analysis tasks such as research, user acceptance testing, and implementation coordination. The position performs liaison activities bringing IT, program, and operational areas together to facilitate translation of business needs into system requirements. This position performs senior-level Product Owner responsibilities in an Agile development environment. The resource acts as a subject matter expert on LTC systems and team processes identifying opportunities for improvement and approving updates. When Production issues arise that impact multiple functions and stakeholders, this position helps coordinate and provide consultation to the vendor for resolution and communication. The position works under minimal supervision, with extensive latitude for the use of initiative and independent judgment.

Essential Job Functions:Project Manager/Senior Product Owner- 50%

Oversee CMD projects and lead business analysts on various initiatives and assigned projects. Coordinates with state programs and vendors to determine priorities of project tasks, activities required to complete tasks, resource allocation, and critical impact on end users. Anticipates and escalates risks and issues. Plans scope, develops benchmarks/timelines, consolidates business user requirements, and manages communications across CMD and HHSC programs. Coordinate development of project work plans and supports all aspects of projects and/or assigned tasks according to scope, budget, and schedules. The Senior Product Owner is responsible for managing the product backlog; prioritizing development of most important features first; coordinating across several team; and developing vision of product by defining features needed by business.

Operations and Production Support - 25%

Performs senior-level research and analysis within LTC systems to identify, troubleshoot, and oversee resolution of issues that impact provider claims payments and service authorizations. Oversees and provides consult/feedback to other business analysts performing the daily operational business activities of monitoring the claims management systems. Troubleshoots and solves problems related to provider claims payments and service authorizations. Communicates effectively to program staff, HHSC leadership, and other stakeholders regarding the business needs and issues. Provides technical claims support assistance to CMD and other program staff. Defines and enforces standards, policies, and procedures used by the team. Mentors and coaches junior team resources.

Facilitation - 15%

Serves as a liaison to facilitate collaborative work across MCS to identify innovative and effective solutions for clients and staff. Communicates across teams, vendors, CMD, program and policy areas, and HHSC IT. Coordinates and facilitates the analysis and determination of business needs and requirements for enhancement projects and modifications to complex automated LTC systems and applications such as TMHP CMS, LTC Provider, SAS, and TMHP LTC Online Portal. Coordinates with business analysts to meet with business users to gather and document user needs and translates into business user requirements and establishes system modification priorities. Reviews expected outcomes to ensure that desired system results are achieved.

Business User Acceptance Testing - 10%

Coordinates and approves user acceptance testing within LTC systems for CMD prior to completion and implementation of projects impacting LTC provider claims payments and service authorizations. Oversees the development of business scenarios that test changes made to automated systems. Monitors the incorporation of system changes into the applications to be tested in the test environment and the testing of those changes to ensure that business requirements have been met. Monitors business end user testing and reviews feedback from users and results to ensure required system modifications meet business requirements. Tracks progress and status of testing and communicates risks and issues to management.

Knowledge Skills Abilities:Knowledge of Texas long-term care claims management payment systems.Knowledge of Texas long-term care assessment and authorization systems.Knowledge of information technology for business applications.Knowledge of Agile Methodology.Knowledge of project management methodology.

Skill in identifying business measures or performance indicators.Skill in coordinating and resolving complex problems.Skill in conducting research and identifying problem resolutions for authorization of LTC services.Skill in leading and supporting multiple projects including project planning, tracking, and coordinating project activities.Skill in developing business user requirements.Skill/experience in conducting/reviewing user testing of automated systems.Skill in eliciting information needed to create user stories and groom the product backlog.

Ability to lead, train, and prioritize the work of others.Ability to plan, assign, and oversee the work of others.Ability to write and revise standards and procedures.Ability to develop, evaluate, and interpret policies and procedures.Ability to prepare reports.Ability to work collaboratively across MCS to accomplish objectives.Ability to communicate effectively, both orally and in writing, with clients/customers to gather requirements and/or explain technical information.

Registration or Licensure Requirements:N/A

Initial Selection Criteria:Required:

Experience working with HHSC LTC Medicaid programs.Experience working in a project management capacity.Experience working as a Senior Product Owner in an Agile Development environment.Experience in user acceptance testing.Experience working with Texas Medicaid & Healthcare Partnership (TMHP).Experience working with payment processing systems and their supporting systems.

Preferred:Preferred experience with Home and Community-Based Services (HCS) and Texas Home Living (TxHmL) Waiver Programs.

Additional Information:1. No resumes. Resumes are not accepted in place of a completed state application. Job histories must demonstrate how you meet the initial selection criteria at a minimum.

2. Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the policy requirements of HHSC Human Resources Manual.

3. Interviews may be conducted online via Microsoft Teams. Applicants should have the ability to meet using virtual meeting tools.

4. This position is eligible for telework in accordance with the HHSC Telework Policies, which includes in-office attendance. Out of state applicants will not be considered.

MOS Code:There may be no military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information see the Texas State Auditor's Military Crosswalk at http://www.hr.sao.state.tx.us/Compensation/JobDescriptions.aspx.

HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.

I-9 Form - Click here to download the I-9 form.

In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

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