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

Description

The Encounter Data Quality Control Analyst (ITBA-SS/AHSO) is responsible for the quality and validity of encounter data and works with Managed Care Organizations (MCO) and Behavioral Health Administrative Service Organizations (BH-ASO) to ensure data accuracy for risk corridors, gain sharing, rate setting, and service-based enhancements. The analyst resolves complex system or payment issues and serves as the agency’s face in data quality meetings with external health care organizations, using communication skills and SQL expertise.

Applicants should be strong facilitators with BABOK experience and a passion for supporting public health data work in Washington.

Provider One is the Health Care Authority’s Medicaid Management Information System (MMIS), operating within the Apple Health Services and Operations (AHSO) Division and Provider One Operations (P1O) section. It processes over five million claims/encounters per month and payments exceeding $14 billion annually statewide.

The position is senior‑level, resides in the Managed Care Operations and Implementation Unit (MCOIU), and reports to the Policy & Planning – Senior/Specialist, MCOIU Manager. It is eligible for telework and typically requires no on‑site reporting, although on‑site attendance in Olympia is required for the first and last day of employment. The default work location is within Washington State.

• Provide subject matter expertise and consultative services for Provider One system changes and enhancements.
• Oversee Provider One encounter data operations and prioritize, analyze, and address issues.
• Monitor encounter data submissions and re‑submissions from HCA contracted MCOs and BH‑ASOs for timeliness, quality, completeness, and validity.
• Engage in executive‑level discussions with HCA and MCO/BH‑ASOs on resolutions to new business changes.
• Lead work groups and staff to develop strategies for implementing new solutions and programs.
• Manage and resolve complex subsystem issues escalated by staff or MCO/BH‑ASOs, directing staff on resolution approaches.
• Liaise and negotiate between business, stakeholders, and vendor (system integrator) to ensure processes and logic consistency.
• Communicate encounter data claim submission requirements with MCO/BH‑ASOs and provide education and training on encounter data exchange standards.
• Maintain the Provider One Encounter Data Reporting Guide, drafting new language and managing updates.
• Serve as the technical specialist on system functionality, features, system issues, and unresolved problems.
• Provide guidance to junior P1O staff on complex issues.
• Perform IT Business Analysis Body of Knowledge (BABOK) disciplines and related methodologies.

• One of the following education and experience options:
  • Option 1:
    Nine (9) years of progressive professional IT experience in 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/supervising staff performing such work.
  • Option 2:
    Associate degree in information technology, computer science, or related field plus seven (7) years of progressive professional IT experience in the areas identified above.
  • Option 3:
    Bachelor’s degree in information technology, computer science, or related field plus five (5) years of progressive professional IT experience.
  • Option 4:
    Master’s degree in information technology, computer science, or related field plus three (3) years of progressive professional IT experience.
  • Option 5:
    Three (3) years as a journey‑level IT professional in state government performing one or more of the experiences listed above.
• Four (4) years of experience with vendor/System Integrator management and facilitating systems development sessions and relationships.
• Two (2) years of knowledge and hands‑on experience with Software Development Life Cycle (SDLC).
• Two (2) years of demonstrated experience with BABOK‑based business analysis methodologies.

• Ability to take action to learn and…