Business Analyst IV (Encounters Analyst)

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage.

Functional Title: Business Analyst IV (Encounters Analyst) Job Title: Information Technology BA IV Agency: Health & Human Services Comm Department: Daily Operations Claims Admin Posting Number: 18079 Closing Date: 06/30/2026 Posting Audience: Internal and External Occupational Category: Business and Financial Operations Salary Range: $7,015.16- $9,439.83 Pay Frequency: Monthly Salary Group: TEXAS-B-27 Shift: Day Additional Shift: Telework: Travel: Up to 15% Regular/Temporary: Regular Full Time/Part Time: Full time FLSA Exempt/Non-Exempt: Exempt Facility Location: Job Location City: AUSTIN Job Location Address: 701 W 51ST ST Other Locations: MOS Codes: 8846,8848,8858,14NX,15AX,16KX,181X,182X,1D7X1,255A,25B,26B,62E,681X,682X,781X,782X,CYB10,CYB11,ISM
IT,Z Prefix


Brief Job Description:

The Texas Medicaid and CHIP Services (MCS) department is seeking a highly qualified Information Technology Business Analyst IV (BA) to join the Encounters and File Support team within the MCS Business Automation Support unit. The position reports to the Manager of Encounters and File Support and performs advanced, senior-level business analysis work that supports the Texas Medicaid Enterprise Systems (MES).


The position focuses on oversight, evaluation, and improvement of encounter and file submissions from Managed Care Organizations (MCO) and Dental Maintenance Organizations (DMO). The Encounters and File Support team manages technical and operational activities related to encounter submissions, ensuring that encounter data is complete, timely, and compliant with state and federal submission requirements. This work supports contract oversight, actuarial rate setting, program monitoring, and federal reporting.


The ideal candidate is a self-starter who exercises sound judgment, works independently with minimal supervision, and excels at analyzing and resolving complex data sets, system, and operational issues. An employee at this level performs advanced business work, supports system maintenance and enhancements, and assists other analysts in identifying, analyzing, and resolving business issues and system issues.

Essential Job Functions (EJFs):

(35%) Data Analysis, Issue Resolution, and Production Support

Leads the analysis of encounter data trends and anomalies to identify complex data issues, operational impacts, and opportunities for improvement. Conducts research on operational challenges, including review of applicable rules, policies, contract requirements and regulations, to assess their impact on automated systems and system functionality. Plans and facilitates workgroups and stakeholder meetings to resolve advanced issues and improve encounter processing and reporting outcomes. Prepares executive-level briefings that summarize findings, impacts, risks, and recommended actions. Provides production support by consulting on application analysis, troubleshooting system problems, coordinating issue resolution, and supporting implementation of effective solutions.

(35%) System Enhancements, Requirements, Testing, and Project Support

Represents the Encounters team on workgroups, meetings, and project initiatives with MCS, IT, MCOs, DMOs, TMHP, and other stakeholders. Assesses program policies and procedures for their impact on encounter processing and data warehouse functions. Gathers, develops, and documents, user requirements for system maintenance, enhancements, and service requests. Prepares project deliverables, including Lean Business Cases (LBCs). Participates in system development activities, including test case review, user acceptance testing, defect tracking, verification, implementation readiness, deployment support, and post-implementation validation.

(15%) Encounter Processing Oversight

Oversee the processing of assigned MCO and DMO encounter submissions. Ensures the accuracy and quality of encounter data through HIPAA and business validation rules. Monitors MCO/DMO performance related to submission timeliness, completeness, and compliance with federal and state standards.

(10%) Vendor Coordination, Readiness Reviews, and Technical Assistance

Evaluates vendor performance and coordinates with vendors and contractors to complete projects, service requests, readiness reviews, and operational reviews. Provides subject matter expertise, technical assistance, and quality assurance support for Medicaid and CHIP encounter processing and reporting initiatives.

(5%) Other Duties and Special Assignments

Performs other assigned duties, including administrative support, training support, and oversight of projects, assignments, and special initiatives.


Knowledge, Skills and Abilities (KSAs):

Knowledge of :

• Texas Medicaid and CHIP Services programs.
• Automated systems concepts and methodologies, including managing joint interface files, understanding end-to-end system processing, and techniques for ensuring accurate and reliable automated data processing.
• Managed care, health care or health insurance industry.
• Health and human services programs and policies.
• Agile or iterative development methodologies.
• Contract performance monitoring and compliance requirements.

Skill in :

• Establishing and maintaining effective professional working relationships.
• Analyzing, interpreting, and communicating advanced operational and data issues.
• Coordinating and facilitating meetings with stakeholders at varying technical levels.
• Translating business needs into clear requirements technical specifications.
• Preparing clear, concise documentation such as requirements, briefings, and recommendations.
• Reviewing complex project deliverables, system documentation, test plans, and technical documentation for accuracy, completeness, and alignment with business needs.
• Resolving data quality issues and developing actionable solutions.
• Tracking and documenting system issues, defects, risks, decisions, and action items through resolution.
• Developing training materials and presenting information clearly to system users and stakeholder groups.
• Using Microsoft Office tools: Excel for analysis, PowerPoint for briefings.

Ability to:

• Work independently with minimal supervision and considerable latitude for initiative while also collaboratively effectively in a team environment.
• Exercise sound judgment when making recommendations or decisions.
• Communicate effectively with technical and non-technical stakeholders.
• Monitor and evaluate encounter data quality, trends, and MCO/DMO performance.
• Recognize, analyze, and resolve advance data, system or operational problems.
• Interpret and apply policies, contract requirements, and regulations to encounter processing and system functionality.
• Provide business and technical assistance to analysts, vendors, contractors, system users, and other stakeholders by clarifying requirements, researching issues, troubleshooting problems, and supporting resolution of encounter processing and reporting issues.
• Develop, review, and validate business requirements, technical specifications, system documentation, and related project documents to ensure they accurately reflect business needs and system functionality to support encounter processing, system maintenance, or system enhancements.
• Develop Lean Business Cases for system enhancements, manage the project's scope, acceptance, implementation, deployment, and post-implementation validation activities.
• Review test case scenarios to validate test results, identify defects, document issues, and confirm that system changes meet approved business requirements.
• Conduct post-implementation validation to confirm that system maintenance or enhancements were implemented as approved and are functioning as intended.
• Review complex project deliverables, including charters, design documentation, test plans, and provide comments and recommendations to document owners.
• Coordinate with outside vendors and contractors to complete projects and service requests, including defining, assigning, and evaluating their work.
• Develop training and conduct formal training sessions covering encounter processing.

Registrations, Licensure Requirements or Certifications:

Leading SAFe® 6.0 Agilist certification or ability to obtain within one year.

Initial Screening Criteria:

Required:

• Five or more years of progressive responsibility in the areas of leading technical initiatives, business analysis, or project management.
• Documented experience as a business analyst or systems analyst, including requirements gathering, issue analysis, or data evaluation.
• Experience researching and interpreting policies, operational rules, or technical documentation.

Preferred:

• Graduation from an accredited four-year college or university with major coursework in business, computer science, information systems, or a health-related field.
• Five years' experience working with healthcare providers, MCOs, DMOs, or external vendors.
• Experience working with Medicaid and CHIP Services programs, particularly managed care.
• Experience processing Medicaid claims, encounters or healthcare data analytics.
• Experience using Agile methodologies and participating in software development lifecycle activities such as testing or acceptance criteria.
• Experience with contract monitoring, auditing or financial monitoring.
• Knowledge of relationships between agency systems related to provider enrollment, client eligibility, claims payment, and data warehouse processes.

Additional Information:

1. Your job history must demonstrate how you meet the initial selection criteria at a minimum.

2. Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the HHSC Human Resources compensation policy.

3. Some travel including occasional overnight trips may be needed.

4. Interviews may be conducted online via Microsoft Teams. Applicants should have the ability to meet using virtual meeting tools.

Review our Tips for Success when applying for jobs at DFPS, DSHS and HHSC.

Active Duty, Military, Reservists, Guardsmen, and Veterans :

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor's Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at View phone number on click.appcast.io. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form

Telework Disclaimer:

This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.