The Claims Management Division (CMD) within the Medicaid and CHIP Services (MCS) Department is responsible for Long Term Care Claims Adjudication through management of the Claims Management System and related support operations.
Per House Bill 1, 88th Legislature, 2023, (Article II, HHSC, Rider 25), beginning on September 1, 2024, HHSC must develop and implement a Texas version of the Nursing Facility (NF) Patient Driven Payment Model (PDPM) methodology for the reimbursement of long-term stay nursing facility services in the Medicaid program to achieve improved care for long-term stay nursing facility services, excluding services provided by a pediatric care facility or any state-owned facilities.
The worker will perform business analyst and support work for the NF PDPM technology project for CMD. These changes impact the Medicaid Management Information System (MMIS)/Medicaid Enterprise Systems (MES) to support the new nursing facility payment methodology for Long-Term Services and Supports.
The worker will serve as a Senior Business Analyst/Product Owner for the NF PDPM project. The Worker will be responsible for delivering quality products that meet the state's desired operational and technical requirements. The worker will have considerable latitude to use their experience and judgement to ensure successful completion of their assigned tasks. The worker will be required to multi-task, analyze priorities, communicate clearly, and set expectations for the phases of the project. The worker will be responsible for communicating with multiple internal and external stakeholders including program and technical staff, and other contracted and vendor resources. The worker will participate in meetings, track deliverables and schedules, and alert management of any issues that may impact providers.
The services to be provided include, but are not limited to the following:
A. Analyzes program policies, procedures, and processes to determine the impact on business systems and functional areas.
B. Analyzes and reviews system, data, and project deliverables such as business user requirements, design documentation, test plans, and risk assessment plans to ensure business and technical requirements are met.
C. Works with program area staff to solicit, analyze and document business processes and requirements.
D. Acts as a liaison between state staff and vendors to translate operational and business requirements to vendors.
E. Serves as the Product Owner for an agile team, including working with agile/scrum teams of contracted software vendors to implement system changes.
F. Analyzes and writes User Stories with Acceptance Criteria based on business needs and according to the Agile methodology.
G. Develops and maintains business user test scenarios and participates in systems and user acceptance testing.
H. Creates use case scenarios, test plans, and exit criteria that accurately map back to the documented business requirements or user stories.
I. Reviews, analyzes and executes test cases with a formal testing tool.
J. Tracks, documents and reports the status of testing.
K. Evaluates proposed test strategies to ensure appropriate test coverage.
L. Identifies potential project risks and issues and develops mitigation strategies,
M. Reports project status to management on established timelines.
N. Documents action items and business decisions.
O. Conducts meetings and/or presentation tasks as needed.
P. Manages schedule for deliverables as established.
Q. Other duties as assigned related to the NF PDPM project.
Candidates that do not meet or exceed the minimum stated requirements (skills/experience) will be displayed to customers but may not be chosen for this opportunity.
|8||Required||Experience in performing complex business analysis and writing technical documentation.|
|8||Required||Experience reporting project status to management including risks, issues, and key decisions.|
|8||Required||Experience identifying project risks and issues; and developing/implementing mitigation strategies.|
|8||Required||Experience in effective general written/oral communication, including documenting requirements, deliverables, test scenarios and project status.|
|8||Required||Experience utilizing business analysis skills and interacting with business end users to gather, validate and document business requirements and translate into technical solutions to satisfy the business needs.|
|8||Required||Experience performing review and approval processes of complex technical user and system requirements written by vendors.|
|8||Required||Experience with Microsoft Office products (Teams, Word, Excel, PowerPoint).|
|8||Required||Experience coordinating and developing test plans/strategies, exit criteria and test scenarios.|
|8||Required||Experience executing detailed test cases within a complex software environment.|
|8||Required||Experience using testing management software.|
|8||Required||Experience with Microsoft Project or similar project management software.|
|8||Required||Experience utilizing the Agile software development methodology.|
|8||Required||Experience as Senior Business Analyst and Agile Product Owner.|
|8||Required||Experience with Medicaid systems and processes.|
|8||Required||Experience in claims processing.|