Job Description

This position is with the Division of Integrated Healthcare in the Office of Managed Healthcare. The Senior Business Analyst (SBA) oversees the exchange of Medicaid and CHIP eligibility, enrollment and/or utilization data between the Department and the Department\'s contracted managed health care plans. This position resolves complex operation and/or data processing issues and monitors system performance; makes recommendations for enhancements; and review systems to ensure compliance with procedures, policies, or regulations. The SBA will assist, as needed, in information analysis support for the Department; work with the Department\'s managed care plans and other technical staff to troubleshoot problems; work closely with the Department of Workforce Services (DWS), Department of Technology Services (DTS), division staff, other government agencies and managed care plans to ensure eligibility and managed care enrollment data is received and processed timely and accurately according to HIPAA, managed care contracts and other business needs.

The SBA resolves a variety of complex eligibility and enrollment issues and may perform a combination of the following tasks: develop, interpret and implement policies and procedures and ensure enforcement; ensure compliance with federal and state rules, regulations and mandates; monitor program and system effectiveness; communicate and coordinate with managed care plans; communicate system issues with other division staff; provide technical expertise; compile statistics, analyze data, and make recommendations. Must be able to communicate effectively, maintain relationships, and work independently as well as part of a team.

Preference may be given to those with experience with Medicaid/CHIP eligibility, managed care enrollment, managed care contracts, eREP, PRISM, Data Warehouse, COGNOS, SQL or database experience.

Note: as of July 1, 2021, State of Utah Employees must either reside in Utah or be in the process of relocating to within 30 days of their start date.

Why work for the Utah Department of Health and Human Services? In addition to the rich the State of Utah offers, the department offers:

• On-site fitness center, for a minimal membership fee
• UTA Eco Pass, at a discounted monthly rate
• Teleworking opportunities
• On-site day care center at the Cannon Health Building with First Steps Day Care - contact for rates and availability, 801-538-6996

For more information on the Utah Department of Health and Human Services, please click .

If offered this position, your employment will be contingent upon passing a background check and review. There will be no cost to you for this check. This check will include fingerprinting, which will be available at various DHHS locations for your convenience. Fingerprinting will be completed prior to your first day of employment. You may review the policy by clicking

Example of Duties

• Review Eligibility and Enrollment Issues
• Create Reports
• Analyze eligibility and enrollment data
• Perform quality checks on eligibility, enrollment and EDI file exchanges
• Draft and update procedural documents.
• Adapts automated system(s) to accommodate special and complex agency needs; designs or enhances unique agency automated systems to interface with existing systems as needed.
• Anticipates the impact that new or modified software will have on existing standards and systems.
• Identifies problems or potential problem areas and recommends solutions.
• Selects testing methods to evaluate the success of both software upgrades and modifications.
• Reviews and/or inspects work for quality, accuracy, and completeness.
• Recommends user level computer system enhancements to better meet customer needs.
• Monitors and evaluates operations, programs, processes and/or practices for quality and effectiveness; makes recommendations for improvement.
• Monitors system performance to ensure proper operation and identify possible problem areas.
• Monitors and evaluates Medicaid and CHIP eligibility and enrollment data.
• Develops eligibility and enrollment reports.

Typical Qualifications

• Create and modify report templates
• Medicaid and CHIP eligibility
• Coordinate computer systems and application design
• Use automated software applications
• Use State or agency-specific software application program(s)
• Communicate information and ideas clearly and concisely in writing; read and understand information presented in writing
• Speak clearly, concisely and effectively; listen to and understand information and ideas as presented verbally
• Make a decision or solve a problem by using logic to identify key facts, explore alternatives and propose quality solutions
• Understand computer hardware and system development
• Use logic to analyze or identify underlying principles, reasons or facts associated with information or data to draw conclusions
• Use computer relational database software
• Evaluate information against a set of standards
• Find, gather and collect information or data
• Understand principles, theories, and practices of computer data storage, retrieval and/or restoration.
• Use multimedia applications
• Test software using appropriate methodology and techniques
• Control or direct the operation of a program or function to include the assessment of organizational needs and the measurement and assessment of outcomes
• Work with or contribute to a work group or team to complete assigned task(s)
• An understanding of applicable laws, rules, regulations and/or policies and procedures
• Ability to thrive in a cross-trained team environment supporting other members as needed

Supplemental Information

• Risks found in the typical office setting, which is adequately lighted, heated and ventilated, e.g., safe use of office equipment, avoiding trips and falls, observing fire regulations, etc.
• Typically, the employee may sit comfortably to perform the work; however, there may be some walking; standing; bending; carrying light items; driving an automobile, etc. Special physical demands are not required to perform the work.

Benefits:
The State of Utah offers eligible employees a variety of benefits including medical, dental, life and disability insurance, as well as a comprehensive leave program. Please click the following link for a detailed information page: . To access a Total Compensation Calculator in Excel format click .

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State of Utah