Job DescriptionJob DescriptionUnder the general supervision of the Section Manager, Program Participation Oversight
(PPO) in the Bureau of Quality & Oversight (BQO), this position is primarily responsible for
the operational administration of the adult long-term care (LTC) provider enrollment system.
1. System Project Management & Oversight
o Serve as the primary point of contact for assigned systems projects.
o Provide operational administration over the adult long-term care (LTC)
provider enrollment system.
o Lead the end-to-end project lifecycle including the development of
businessrequirements, review of design documentation, flowcharts, file and report
layouts, coordinate User Acceptance Testing, and conduct Production
Verification to ensure the system changes meets BQO and DMS needs.
o Identify and document data inconsistencies or system bugs and work with
vendors to resolve operational issues.
o Provide direction and technical assistance to internal and external teams to
update, manage, analyze the system.
2. Data Analysis & Policy Support
o Utilize SAS and OnBase case and project tracking systems to execute regular
and ad hoc queries from the EDW/DAR for data extraction in support of
advancing adult provider enrollment, assess network adequacy, and conduct
other policy research as assigned.
o Analyze department policies, state and federal regulations, statutes,
administrative codes and guidelines to inform necessary maintenance and
enhancements to assigned systems areas.
o Learn and understand data, interfaces, and extracts and make conclusions to
be presented to leadership for decision making purposes.
o Conduct review of trends and utilization patterns of adult LTC provider
enrollment related data, interfaces, and extracts systems and make
recommendations to management.
o Update, input and maintain the adult LTC provider enrollment system
integrity and user reliability.
o If applicable, conduct research and provide ongoing information and
consultation to BQO leadership and vendor(s) to maintain and improve adult
LTC provider enrollment system operations.
3. Coordination & Collaboration
o Independently resolve problems by working with appropriate staff or vendor
staff to identify and resolve any conflicts in the adult LTC provider
enrollment system and its operation(s).
Knowledge Services RFS Summary
2
o Meet with BQO staff, contracted agencies, and long-term care providers to
determine systems problems, prepare analysis of identified problems,
develop systems specifications and tests to correct problems and monitor
their implementation.
o Present data in a usable format for BQO staff and leadership in the
appropriate form of charts, graphs, reports and tables.
o When requested, present data orally with appropriate presentation
materials.
o Independently work with appropriate staff or vendor staff to identify,
research, and resolve data, interfaces, and extracts validity and integrity
issues.
Position Skills, Abilities, and Knowledge:
• Proficient knowledge of the Medicaid MMIS including the systems operated by the
fiscal agent (interChange and OnBase), the EDW/DAR (SAS), and the
eligibility/enrollment system (CARES) including the basic operation of these systems
and their capabilities.
• Experience with the system development life cycle, with skills in the areas of
business requirements development and ensuring consistent quality.
• Extensive knowledge of Microsoft Excel, SAS Systems, Tableau, and/or other data
analysis software.
• Knowledge of research design methods, management reporting techniques, and
statistics.
• Advanced oral and written communication and presentation skills.
• Knowledge of the State of Wisconsin adult long-term care programs.
• Extensive knowledge of Medicaid and other health care program reporting and data.
• Knowledge and ability to analyze large datasets and interpret results from statistical
tools.
• Extensive knowledge of Federal Health Insurance Portability and Accountability Act
(HIPAA) regulations and transaction and data standards.
• Ability to work independently and as part of a team.
• Skill in conducting meetings and working effectively with people.
• Skill in the use of problem-solving techniques involving complex situations and
multiple viewpoints.
• Demonstrated ability to collaborate with public and private agencies and service
delivery systems.
• Experience working in a complex, matrix work environment.
Hours
Required
Monday through Friday, 8:00 a.m. 5:00 p.m.
Work Location This position is remote and work must be performed within the State of Wisconsin. Selected
candidate will be required to be onsite in Madison, Wisconsin once a month.
RequirementsTop Skills & Years of Experience: 3 to 5 years of experience performing a
business analyst role supporting State Medicaid and MMIS, or similar health care
business o System Project Management and Oversight
o Data Analysis and Policy Support
o Coordination and Collaboration
Nice to have skills:
o Certified
Business Analysis Professional (CABP) preferred
o Excellent interpersonal communication skills
o Excellent organization and time management skills
Additional Details: Industry skills and experience
o 3 to 5 years of experience performing a
business analyst role supporting State Medicaid and MMIS, or similar health care
businessand system in one or more of the following functional areas:
- Provider management
- Member (recipient) eligibility and enrollment
- Claims and encounters
- Benefit plan
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