The Business Analyst (BA) IV reports to the Manager of Claims Services (CS) within the Claims Management Division (CMD). This position leads work on complex CMD initiatives supporting Long-Term Care (LTC) service authorizations and claims. The Business Analyst IV provides leadership on initiatives that may cross multiple program areas, teams, and vendors. The position oversees the work efforts of other resources performing business analysis tasks such as research, user acceptance testing, and implementation coordination. The BA IV performs liaison activities bringing vendors, 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 vendors for resolution and communication.
Essential Job Functions:
Analysis and Research – Oversees business analysis and research across multiple systems by the Claims Support (CS) team within CMD. Performs senior-level research and analysis within LTC systems to identify, troubleshoot, and oversees resolution of issues that impact provider claims payments and service authorizations. Verifies and approves proposed business requirements, scope, timelines, business plans, or enhancements for LTC systems. (30%)
Operations and Production Support – Oversees and provides consult/feedback to other business analysts performing the daily operational business activities of monitoring the claims management systems, troubleshooting, and solving problems related to provider claims payments and service authorizations. Communicates effectively to Claims Management, program staff, HHSC leadership, and other stakeholders on business needs and issues; and provides technical claims support assistance to Claims Management staff and program staff. Defines and enforces standards, policies, and procedures used by the team. Provides technical assistance to CMD staff, HHSC staff, and other program staff. Mentors and coaches junior team resources. (30%)
Business User Acceptance Testing – 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. (10%)
Project Management Team/Senior Product Owner – Oversees CMD projects and leads 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 for tasks, and critical impact on end users through risk analysis. Anticipates and escalates risks and issues. Plans scope, develops benchmarks/timelines, consolidates business user requirements, and manages communications across CMD and HHSC Programs. Coordinates development of project work plans and supports all aspects of projects and/or assigned tasks according to scope, budget, and schedules. Product Owners are responsible for overseeing the development and prioritization of user stories. The Product Owner ensures that implemented features meet the business need. Product Owners manage the product backlog. (10%)
Liaison – Facilitates collaborative work across Medicaid and CHIP Services (MCS) to identify innovative and effective solutions for clients and staff. Serves as a liaison between 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 impacted business users to gather and document user needs and translates into business user requirements. Reviews expected outcomes to ensure that desired system results are achieved. Facilitates analysis meetings with business users to determine the business needs that can be translated into the business system requirements and works with
business users to establish system modification priorities. (20%)
Knowledge Skills Abilities:
Knowledge of the limitations and capabilities of business applications and techniques used in the design of non-automated systems
Knowledge of claims management payment systems
Knowledge of information technology for business applications
Knowledge of Agile Methodology
Skill in identifying business measures or indicators of performances
Skill in coordinating and solving complex problems
Skill in researching and problem resolutions for member enrollment and 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:
Initial Selection Criteria:
Experience working with HHSC Medicaid programs
Experience working in a project management or Production Manager capacity.
Experience in user acceptance testing
Experience working with Texas Medicaid & Healthcare Partnership (TMHP)
Experience working with payment processing systems and their supporting systems
Experience with Long Term Care rules and policies
Additional Information:
Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual.
MOS Code:
Note: 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
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