GovernmentJobs.com
CO Medicaid Enterprise Solutions (CMES) Integration Business Analyst
GovernmentJobs.com, Aurora, Colorado, United States, 80012
CO Medicaid Enterprise Solutions (CMES) Integration Business Analyst
The State of Colorado strives to create a Colorado for All by building and maintaining workplaces that value and respect all Coloradans through a commitment to equal opportunity and hiring based on merit and fitness. The State is resolute in non-discriminatory practices in everything we do, including hiring, employment, and advancement opportunities. The Department of Health Care Policy & Financing (HCPF) oversees and operates Health First Colorado (Colorado's Medicaid Program), Child Health Plan Plus (CHP+), and other state public health programs for qualified Coloradans. Our mission is to improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado. We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities. As part of the State of Colorado, HCPF offers a competitive benefits package: PERA retirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans Medical, dental, and vision insurance coverage Automatic Short-Term and Optional Long-Term Disability Coverage Life and AD&D Insurance Flexible Spending Accounts (FSAs) Family Medical Leave Act (FMLA) job protection and State of Colorado Paid Family Medical Leave (PFML) 11 Paid Holidays Annually and Accrued Annual and Sick Leave Accrued Sick Leave for State of Colorado Temporary Employees Flexplace and Flextime work arrangements Variety of discounts on services and products available through the State of Colorado's Work-Life Employment Discount Program Free RTD EcoPass to all eligible State Employees Reduced college tuition through CSU Global Credit Union of Colorado Membership Eligibility Some positions may qualify for the Public Service Loan Forgiveness Program. We are looking for a CO Medicaid Enterprise Solutions (CMES) Integration Business Analyst for the Health Information Office (HIO)! HIO exists to manage and enhance computerized claims processing and information management systems in order to assure timely and accurate Medicaid and Child Health Plan Plus (CHP+) claims processing and payments in an environment of rapid policy change. It also exists to improve budget forecasting and monitoring capabilities and improve program management of Medicaid programs with an annual budget of over fourteen billion dollars. This position can work fully remotely from anywhere in the State of Colorado. Please note - equipment provisioning and certain onboarding tasks will take place in person, in our downtown Denver office, on the first day of employment. Description of Job
WHAT YOU'LL BE DOING AS CMES INTEGRATION BUSINESS ANALYST: Document and manage requirements for integration enhancements of the Enterprise Data Warehouse (EDW), Program Integrity (PI), Recoveries Database (RED), Patient Access and Interoperability (PAI), Medicaid Management Information System (MMIS), Care & Case Management (CCM), Electronic Visit Verification (EVV), Electronic Data Interface (EDI) and eConsult modules. Analyze and validate data and interface transmission for the CMES to ensure system processes are aligned with the Medicaid & CHP+ regulatory and programmatic rules. Subject matter expert in the technical aspects of Claims-Financial and Long-term Services & Support (LTSS) portfolio modules including claims processing, eligibility and enrollment data, financial payment data, provider enrollment data, third party liability data and assessment data. Communicate system strategies with various operations, financial, policy, program and technical staff. Research the system functions to discover information, expose and resolve problems, identify workarounds, and evaluate the sustainability and configurability of system change across the CMES. Ensure system change is documented and traceable from scope and requirements, to testing and implementation. Identify and recommend potential operational and systematic alternatives or "workarounds" for features that are not functioning as expected or able to be delivered on time. Analyze CMES data quality by researching and reviewing data models, data dictionaries, interface control documents, interface transactions, reports and files and by ensuring all documentation and data is kept up to date and in compliance with ESI standards. Research, develop, and analyze data queries in the ESI Operational Data Store or other sources, and for reporting and communicating the results to Department Staff. Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights
Residency Requirement: This posting is only open to residents of the State of Colorado at the time of submitting your application. Class Code & Classification Description: H1C3XX ANALYST III MINIMUM QUALIFICATIONS: There are two ways to qualify for this position: Option 1:
Experience Only: Six (6) total years of professional experience in Medicaid/CHP Operations and/or health care systems development, project management, business analysis, or closely related fields Option 2:
Education and Experience: Bachelor's degree from an accredited institution in Policy Administration, Health Care Policy, Business Administration, Information Technology, Computer Science, or a closely related field AND Two (2) total years of professional experience in Medicaid/CHP Operations and/or health care systems development, project management, business analysis, or closely related fields Appropriate education will substitute for the required experience on a year-for-year basis. Relevant education will be calculated as the following: An associate's will count as two years of experience A bachelor's will count as four years of experience A master's degree will count for six years of experience A doctorate or juris doctorate degree will count for seven years of experience PREFERRED QUALIFICATIONS Previous relevant professional state experience Masters degree in Information Technology OR Certification in Business Analysis OR Certification in Project Management Professional experience with Medicaid or CHP Programs Skills to Support Success Ability to translate health care policy in business requirements Commitment to keeping promises and meeting deadlines Ability to work in a team environment remotely and in-person developing relationships across an organization that promote innovation and collaboration Flexible, must be able to lead meetings and take direction at the same time Ability to communicate technical details to a non-technical audience Conditions of Employment All positions at HCPF are security sensitive positions and require that the individuals undergo a criminal record background check as a condition of employment. Employees who have been disciplinary terminated, resigned in lieu of disciplinary termination, or negotiated their termination from the State of Colorado must disclose this information on the application. Appeal Rights If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director. An appeal or review must be submitted on the official appeal form, signed by you or your representative. This form must be delivered to the State Personnel Board by email, postmarked in US Mail or hand delivered (1525 Sherman Street, 4th Floor, Denver CO 80203), or faxed (303.866.5038) within ten (10) calendar days from your receipt of notice or acknowledgement of the department's action. For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board; go to spb.colorado.gov; contact the State Personnel Board for assistance at (303) 866-3300; or refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov under Rules.
The State of Colorado strives to create a Colorado for All by building and maintaining workplaces that value and respect all Coloradans through a commitment to equal opportunity and hiring based on merit and fitness. The State is resolute in non-discriminatory practices in everything we do, including hiring, employment, and advancement opportunities. The Department of Health Care Policy & Financing (HCPF) oversees and operates Health First Colorado (Colorado's Medicaid Program), Child Health Plan Plus (CHP+), and other state public health programs for qualified Coloradans. Our mission is to improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado. We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities. As part of the State of Colorado, HCPF offers a competitive benefits package: PERA retirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans Medical, dental, and vision insurance coverage Automatic Short-Term and Optional Long-Term Disability Coverage Life and AD&D Insurance Flexible Spending Accounts (FSAs) Family Medical Leave Act (FMLA) job protection and State of Colorado Paid Family Medical Leave (PFML) 11 Paid Holidays Annually and Accrued Annual and Sick Leave Accrued Sick Leave for State of Colorado Temporary Employees Flexplace and Flextime work arrangements Variety of discounts on services and products available through the State of Colorado's Work-Life Employment Discount Program Free RTD EcoPass to all eligible State Employees Reduced college tuition through CSU Global Credit Union of Colorado Membership Eligibility Some positions may qualify for the Public Service Loan Forgiveness Program. We are looking for a CO Medicaid Enterprise Solutions (CMES) Integration Business Analyst for the Health Information Office (HIO)! HIO exists to manage and enhance computerized claims processing and information management systems in order to assure timely and accurate Medicaid and Child Health Plan Plus (CHP+) claims processing and payments in an environment of rapid policy change. It also exists to improve budget forecasting and monitoring capabilities and improve program management of Medicaid programs with an annual budget of over fourteen billion dollars. This position can work fully remotely from anywhere in the State of Colorado. Please note - equipment provisioning and certain onboarding tasks will take place in person, in our downtown Denver office, on the first day of employment. Description of Job
WHAT YOU'LL BE DOING AS CMES INTEGRATION BUSINESS ANALYST: Document and manage requirements for integration enhancements of the Enterprise Data Warehouse (EDW), Program Integrity (PI), Recoveries Database (RED), Patient Access and Interoperability (PAI), Medicaid Management Information System (MMIS), Care & Case Management (CCM), Electronic Visit Verification (EVV), Electronic Data Interface (EDI) and eConsult modules. Analyze and validate data and interface transmission for the CMES to ensure system processes are aligned with the Medicaid & CHP+ regulatory and programmatic rules. Subject matter expert in the technical aspects of Claims-Financial and Long-term Services & Support (LTSS) portfolio modules including claims processing, eligibility and enrollment data, financial payment data, provider enrollment data, third party liability data and assessment data. Communicate system strategies with various operations, financial, policy, program and technical staff. Research the system functions to discover information, expose and resolve problems, identify workarounds, and evaluate the sustainability and configurability of system change across the CMES. Ensure system change is documented and traceable from scope and requirements, to testing and implementation. Identify and recommend potential operational and systematic alternatives or "workarounds" for features that are not functioning as expected or able to be delivered on time. Analyze CMES data quality by researching and reviewing data models, data dictionaries, interface control documents, interface transactions, reports and files and by ensuring all documentation and data is kept up to date and in compliance with ESI standards. Research, develop, and analyze data queries in the ESI Operational Data Store or other sources, and for reporting and communicating the results to Department Staff. Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights
Residency Requirement: This posting is only open to residents of the State of Colorado at the time of submitting your application. Class Code & Classification Description: H1C3XX ANALYST III MINIMUM QUALIFICATIONS: There are two ways to qualify for this position: Option 1:
Experience Only: Six (6) total years of professional experience in Medicaid/CHP Operations and/or health care systems development, project management, business analysis, or closely related fields Option 2:
Education and Experience: Bachelor's degree from an accredited institution in Policy Administration, Health Care Policy, Business Administration, Information Technology, Computer Science, or a closely related field AND Two (2) total years of professional experience in Medicaid/CHP Operations and/or health care systems development, project management, business analysis, or closely related fields Appropriate education will substitute for the required experience on a year-for-year basis. Relevant education will be calculated as the following: An associate's will count as two years of experience A bachelor's will count as four years of experience A master's degree will count for six years of experience A doctorate or juris doctorate degree will count for seven years of experience PREFERRED QUALIFICATIONS Previous relevant professional state experience Masters degree in Information Technology OR Certification in Business Analysis OR Certification in Project Management Professional experience with Medicaid or CHP Programs Skills to Support Success Ability to translate health care policy in business requirements Commitment to keeping promises and meeting deadlines Ability to work in a team environment remotely and in-person developing relationships across an organization that promote innovation and collaboration Flexible, must be able to lead meetings and take direction at the same time Ability to communicate technical details to a non-technical audience Conditions of Employment All positions at HCPF are security sensitive positions and require that the individuals undergo a criminal record background check as a condition of employment. Employees who have been disciplinary terminated, resigned in lieu of disciplinary termination, or negotiated their termination from the State of Colorado must disclose this information on the application. Appeal Rights If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director. An appeal or review must be submitted on the official appeal form, signed by you or your representative. This form must be delivered to the State Personnel Board by email, postmarked in US Mail or hand delivered (1525 Sherman Street, 4th Floor, Denver CO 80203), or faxed (303.866.5038) within ten (10) calendar days from your receipt of notice or acknowledgement of the department's action. For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board; go to spb.colorado.gov; contact the State Personnel Board for assistance at (303) 866-3300; or refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov under Rules.