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

Description This position is responsible for the quality and validity of encounter data and for 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. The analyst will also resolve complex system or payment issues, serve as the face of the agency in data quality meetings with external health care organizations, and use SQL skills to perform data quality work. Strong facilitation skills, BABOK experience, and an interest in supporting important public health data work in Washington required. About the Division ProviderOne is the Health Care Authority’s (HCA) mission‑critical Medicaid Management Information System (MMIS). This enterprise system is operated and managed within the Apple Health Services and Operations (AHSO) Division, ProviderOne Operations (P1O) section and processes over five million claims/encounters per month, handling payments in excess of $14billion annually to Medicaid providers statewide. About the Position This senior‑level role resides within the Managed Care Operations and Implementation Unit (MCOIU) and reports to the Policy & Planning – Senior/Specialist, MCOIU Manager. It is responsible for providing detailed information technology services for the ProviderOne MMIS and is eligible for telework. On‑site work in Olympia, WA may be required for initial and final days of employment. This position applies an equity lens to all work, including all analyses of core business and processes. Duties Provide subject‑matter expertise and skilled consultative service for ProviderOne system changes and enhancements. Oversee ProviderOne encounter data operations and prioritize, analyze, and address issues. Monitor encounter data submissions and re‑submissions from HCA contracted MCOs and BH‑ASOs, evaluating data for timeliness, quality, completeness, and validity within stringent timelines. Engage in executive‑level discussions on resolutions to new business changes. Provide direction and oversight to workgroups and staff to develop strategy for implementing new solutions and programs. Manage and resolve complex subsystem issues escalated by staff or MCO/BH‑ASOs, directing staff on approaches for resolution. Liaise and negotiate between business stakeholders and the vendor (system integrator) to ensure consistency, understanding, and efficiency in processes and logic. Communicate encounter data claim submission requirements with the MCO/BH‑ASOs and provide education and training for them regarding encounter data exchange standards. Maintain the ProviderOne Encounter Data Reporting Guide, drafting new language and managing updates. Act as the technical specialist on system functionality, features, system issues, and unresolved system problems. Provide guidance to junior P1O staff on complex issues. Apply IT Business Analysis Body of Knowledge (BABOK) disciplines and related methodologies. Qualifications Required Qualifications Option 1: Nine (9) years of progressive professional IT experience in areas such as consulting, analyzing, designing, programming, installing, or maintaining software, hardware, telecommunications, or network infrastructure equipment; directing IT projects; providing IT customer or technical support; or administering/supervising staff who performed work in 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 the areas identified in Option1. 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 the areas identified in Option1. Option 4: Master’s degree in information technology, computer science, or IT‑related field (or equivalent) and three (3) years of progressive professional IT experience in the areas identified in Option1. Option 5: Three (3) years as a career‑level IT professional in state government performing one or more of the experiences listed in Option1. All applicants must also satisfy the following concurrent criteria: 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 best‑practice Business Analysis methodologies based on the International Institute of Business Analysis, BABOK Guide and Standards. Required Competencies The ability to take action to learn and grow. The ability to take action to meet the needs of others. Preferred Qualifications Using SQL to write and pull data queries. Analyzing large, complex data sets used to make highly visible enterprise‑wide decisions. Effectively communicating orally and in writing with large groups (100+ ) of internal and external stakeholders regarding detailed and/or technical content, such as contract language and deliverables. Facilitating meetings with external stakeholders. Building reports and creating data extracts from a data warehouse. Highly skilled level analytical, facilitation, systems and organizational skills. Commitment to Equity 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. #J-18808-Ljbffr