Medicaid Business Analyst | Austin, TX

Medicaid Business Analyst

Client : Texas Health and Human Services (HHSC)

Location : Greater Austin, TX(Need local)

Job Details

Position will be 4 days remote with 1 day (Tuesdays) required to be onsite at the location listed above. Candidates who are LOCAL ONLY to the Greater Austin Area

The Claims Management Division (CMD) within the Medicaid and CHIP Services (MCS) Department is responsible for Long Term Care (LTC) Claims Adjudication through management of the Claims Management System and related support operations maintained by the Texas Medicaid & Healthcare Partnership (TMHP).

The TMHP contract previously held by Accenture expired on August 31, 2023. HHSC procured two new vendor contractors who operate different contracts performing business operations, claims adjudication and financial services, and system maintenance and development activities for state owned Medicaid Enterprise Systems (MES). Implementing these contracts requires technology changes to implement and integrate existing applications with a new claims system to ensure providers are paid, services are authorized, and providers are enrolled. The modernization and critical projects that are prioritized and affect LTC claims processing and related systems are required to support successful MES transition, day one claim processing, and critical functionality. Resources will be needed to support these modifications.

The Worker will serve as a senior Business Analyst/Product Owner for the modernization projects. The Worker will be responsible for delivering quality products that meet the state's desired operational and technical requirements. The worker will have considerable latitude to use their experience and judgement to ensure successful completion of their assigned tasks. The Worker will be required to multi-task, analyze priorities, communicate clearly, and set expectations for the phases of the project. The worker will be responsible for communicating with multiple internal and external stakeholders including program and technical staff, and other contracted and vendor resources. The Worker will participate in meetings, track deliverables and schedules, and alert management of any issues that may impact providers.

CANDIDATE SKILLS AND QUALIFICATIONS

The services to be provided include, but are not limited to the following:

• Analyzes program policies, procedures, and processes to determine the impact on business systems and functional areas.
• Analyzes and reviews system, data, and project deliverables such as business user requirements, design documentation, test plans, and risk assessment plans to ensure business and technical requirements are met.
• Works with program area staff to solicit, analyze and document business processes and requirements.
• Acts as a liaison between state staff and vendors to translate operational and business requirements to vendors.
• Serves as the Product Owner for an agile team, including working with agile/scrum teams of contracted software vendors to implement system changes.
• Analyzes and writes User Stories with Acceptance Criteria based on business needs and according to the Agile methodology.
• Develops and maintains business user test scenarios and participates in systems and user acceptance testing.
• Creates use case scenarios, test plans, and exit criteria that accurately map back to the documented business requirements or user stories.
• Reviews, analyzes and executes test cases with a formal testing tool.
• Tracks, documents and reports the status of testing.
• Evaluates proposed test strategies to ensure appropriate test coverage.
• Identifies potential project risks and issues and develops mitigation strategies,
• Reports project status to management on established timelines.
• Documents action items and business decisions.
• Conducts meetings and/or presentation tasks as needed.
• Manages schedule for deliverables as established.
• Other duties as assigned related to the project.