Enterprise Services Integration (ESI) Data & Business Analyst

Enterprise Services Integration (ESI) Data & Business Analyst

We are looking for an Enterprise Services Integration (ESI) Data & Business Analyst for the Enterprise Solution Integration (ESI) Division of the Health Information Office (HIO)! The ESI Division of 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 the management of the Medicaid programs data integration files transmission across the Colorado Medicaid Enterprise System (CMES). The work section is responsible for researching, verifying and validating the transmission of data and integration functions and processes through the Enterprise Solutions Integration Platform and across the Colorado interchange System (iC), also known as the MMIS System, the Pharmacy Benefits Management System (PBMS), the Enterprise Data Warehouse (EDW) System, the Enterprise Testing Vendor (ETV), the Provider Call Center Module (PCC), the Electronic Data Interchange (EDI), the Program Integrity & Electronic Recovery Module (PI/RED) Electronic Visit & Verification Module (EVV), Care and Case Management Module (CCM), Social Health Information Exchange Module (SHIE), Providers of Distinction (PoD) and following the project management and portfolio management best practices and standards utilized by the Enterprise Project Management Office (EPMO). Additionally, the work unit supports the various State and Federal regulatory policy and audits of the systems, and resulting Medicaid claims reimbursement, provider enrollment and medical benefit coverage, by providing research and validation of the data mapping and transmissions of the interface files and APIs to ensure Medicaid data is mapped accordingly to the State and Federal regulatory policies and rules.

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 ESI Data & Business Analyst:

• As Staff Authority, supports the Department and the State of Colorado by building a data integration system across the Colorado Medicaid Enterprise Systems platform (CMES).
• Responsible for the successful implementation of data quality integrations across the CMES Ecosystem, directing Medicaid data access across CMES Ecosystem.
• Relied on by Contract Vendors, Department Management, and Stakeholders for day-to-day operational support to ensure Medicaid data exchanges occur between the CMES platform and other module systems.
• Analyzes, identifies and mitigates business and operational impacts to the Enterprise, APIs & interface files that are critical to the success of data exchanges with the Module Vendors, with the understanding that many of these requests originate from State and Federal legislative mandates.
• Develops and executes advanced planning strategies with EPMO, BSD, Health IT, Contract Management and Testing Divisions within HCPF as well as CMES module vendors.
• Implements and executes data and integration process changes within the CMES & ESI Integration platform supporting both a waterfall and agile methodology environment.
• Implements data modeling changes within the CMES by collaborating with cross functional teams and ensuring consistency with enterprise data architecture.
• Directs and executes the work to elicit, document and manage all stages of the ESI SDLC methodology to ensure each stage of the process is managed throughout the life of the project.
• Elicits and manages high level business requirements (HLBR), integration business requirements, functional, non-functional and transitional requirements.
• Evaluates, communicates, and manages the funding, systems integration, and capacity risks identified for system changes, as well as responding to legislative fiscal impact requests, federal and state audit requests, and federal system certification requirements validation requests.

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: H1C4XXANALYST IV

MINIMUM QUALIFICATIONS:

There are two ways to qualify for this position:

• Option 1: Experience Only: Seven (7) total years of professional experience managing business processes, vendors, and staff teams for large, complex systems while guiding the Software Development Life Cycle.
• Option 2: Education and Experience: Bachelor's degree from an accredited institution in Health Care Administration, Business Administration, or a related field AND Three (3) total years of professional experience managing business processes, vendors, and staff teams for large, complex systems while guiding the Software Development Life Cycle. 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
• Professional experience:
• Working in a large claims processing system and/or knowledge of Medicaid and Pharmacy benefits and services.
• In program management assisting in the development of programs to support an organization's strategic direction, including creating and managing long term goals, complex problem solving, understanding and managing data interface files, vendor management, and/or writing program funding proposals.
• Working as a Systems Business Analyst, documenting business requirements and reviewing and approving design and development documents for large scale medical claims processing systems or medical information systems.
• Working for or in partnership with a State Medicaid Agency.
• DEFINITION OF PROFESSIONAL EXPERIENCE:
• Work that involves exercising discretion, analytical skill, judgment, personal accountability, and responsibility for creating, developing, integrating, applying, and sharing an organized body of knowledge that characteristically is uniquely acquired through an intense education or training regimen at a recognized college or university; equivalent to the curriculum requirements for a bachelor's or higher degree with major study in or pertinent to the specialized field; and continuously studied to explore, extend, and use additional discoveries, interpretations, and application and to improve data, materials, equipment, applications and methods.
• 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 (dpa_state.personnelboard@state.co.us), 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.