Encounter Data Quality Control Analyst; ITBA-SS​/AHSO

Position: Encounter Data Quality Control Analyst (ITBA-SS/AHSO)
Encounter Data Quality Control Analyst (ITBA-SS/AHSO)

This position is responsible for the quality and validity of encounter data and working with Managed Care Organizations (MCO) and Behavioral Health Administrative Service Organizations (BH-ASO) to ensure accurate and complete data that is used for risk corridors, gain sharing, rate setting and service-based enhancements. This position will also resolve any complex system or payment issues. This analyst uses communication skills as the face of the agency data quality meetings with external health care organizations as well as SQL skills in performing data quality work.

If you are a strong facilitator with BABOK experience and an interest in supporting important public health data work in Washington, this may be the opportunity for you!

All HCA employees will apply an equity lens to their work, which may include but is not limited to all analyses of core business and processes.

About the division:

Provider One is the Health Care Authority's (HCA) mission critical Medicaid Management Information System (MMIS). This large-scale enterprise system is operated and managed within the Apple Health Services and Operations (AHSO) Division, Provider One Operations (P1O) section and processes over five million claims/encounters per month and processes payments in excess of $14 billion annually to providers for services to Medicaid clients statewide.

About the position:

This senior-level Encounter Data Quality Control Analyst position resides within the Managed Care Operations and Implementation Unit (MCOIU) and reports to the Policy & Planning - Senior/Specialist, MCOIU Manager. This position is responsible for providing a detailed level of information technology services for the Provider One MMIS.

This position is eligible to telework and is typically not required to report on-site. The default assigned work location of all Health Care Authority (HCA) positions - both on-site and telework eligible positions - is within the State of Washington. This position reports to Olympia, WA. Frequency of onsite work will vary based on business and operational needs. All agency employees are required to report on-site in Olympia on their first and last days of employment to pick up and return state-issued equipment, regardless of telework status or location.

Some of what you will do:

* Provide subject matter expertise and skilled consultative service for Provider One system changes and enhancements.

* Oversee Provider One encounter data operations and prioritize, analyze, and address issues

* Within stringent timelines, monitor encounter data submissions and re-submissions from HCA contracted Managed Care Organizations (MCO) and Behavioral Health Administrative Service Organizations (BH-ASO), evaluating encounter data for timeliness, quality, completeness, and validity.

* Engage in discussions at the executive level (with HCA and MCO/BH-ASOs) on possible resolutions to new unfolding business changes.

* Provide direction and oversight to work groups and staff in order to develop strategy for implementing new solutions and programs.

* Manage and resolve complex subsystem issues that are escalated by staff or the MCO/BH-ASOs. Directs staff on approaches for resolving these issues.

* Liaise and negotiate between the business, stakeholders, and vendor (system integrator) to ensure consistency, understanding, and efficiency in processes and logic.

* Communicate encounter data claims submission requirements with the MCO/BH-ASOs. Provide education and training for these organizations regarding encounter data exchange standards.

* Responsible for maintaining the Provider One Encounter Data Reporting Guide including drafting new language as well as managing updates.

* Function as the technical specialist on system functionality, features, system issues, and unresolved system problems

* Provide guidance to junior P1O staff on complex issues.

* Perform IT Business Analysis Body of Knowledge (BABOK) disciplines and related methodologies.

Required qualifications:

Qualifying candidates will satisfy one of the following criteria options:

Option 1:

* Nine (9) years of progressive professional IT experience in one or more of the following areas:

* consulting, analyzing, designing, programming, installing, and/or maintaining computer software applications, hardware, telecommunications, or network infrastructure equipment;

* directing IT projects;

* providing IT customer or technical support; or

* administering or supervising staff who performed work in any of these IT disciplines.

Option 2:

* Associate degree in information technology, computer science, or IT related field or equivalent and

* Seven (7) years of progressive professional IT experience in one or more of the areas identified in Option 1.

Option 3:

* Bachelor's degree in information technology, computer science, or IT related field or equivalent and

* Five (5) years of progressive professional IT experience in one or more of the areas identified in…