Business Analyst III (Encounter 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 III (Encounter Analyst)

Job Title: Information Technology BA III

Agency: Health & Human Services Comm

Department: Claims Management (50/50)

Posting Number: 21163

Closing Date: 09/22/2026

Posting Audience: Internal and External

Occupational Category: Business and Financial Operations

Salary Range: $5,797.66 - $9,508.25

Pay Frequency: Monthly

Salary Group: TEXAS-B-25

Shift: Day

Additional Shift:

Telework:

Travel: Up to 25%

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

Job Description

The Texas Medicaid and CHIP Services (MCS) department is seeking a highly qualified Information Technology Business Analyst III (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 highly complex (senior-level) business analysis activities that support the Texas Medicaid Enterprise Systems (MES), with a primary focus on oversight, evaluation, and improvement of encounter and file submissions from Managed Care Organizations (MCOs) and Dental Maintenance Organizations (DMOs).

The Encounters and File Support team manages all technical activities related to encounter submissions, ensuring that encounter data received from MCOs and DMOs 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, can work independently with limited supervision, and excels at solving complex data and operational problems.

Essential Job Functions

Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.

(30%) Oversees 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.

(30%) Leads the analysis of encounter data trends and anomalies. Plans and facilitate workgroup and stakeholder meetings to resolve data issues and improve reporting outcomes. Conducts research on operational challenges, including review of applicable rules, policies, and regulations. Prepares executive-level briefings that summarize findings, risks, and recommended actions.

(20%) Represents the Encounters team on workgroups, meetings, and project initiatives with MCS, IT, MCOs, DMOs, and TMHP. Assesses program policies and procedures for their impact on encounter processing and data warehouse functions. Gathers, develops, and documents user requirements for system enhancements and automation. Prepares project deliverables, including Lean Business Cases (LBCs). Participates in development activities such as testing, verification, and approval of new system implementations, and provides quality assurance support for complex projects.

(15%) Evaluates vendor performance for compliance and service readiness. Provides subject matter expertise and technical assistance during readiness and operational reviews of Medicaid and CHIP encounter processing and reporting.

(5%) Performs other assigned duties, including administrative support and oversight of projects, assignments, and special initiatives.

Knowledge, skills, Abilities

Knowledge of:

• Texas Medicaid and CHIP Services programs.
• Automated systems concepts and methodologies, including managing 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 complex operational and data issues.
• Coordinating and facilitating meetings with stakeholders at varying technical levels.
• Preparing clear, concise documentation such as requirements, briefings, and recommendations.
• Reviewing technical requirements and collaborating effectively with product owners and vendor teams.
• Identifying data quality issues and developing actionable solutions.
• Using Microsoft Office tools: Excel for analysis, PowerPoint for briefings.

Ability to:

• Monitor and evaluate encounter data quality, trends, and MCO/DMO performance.
• Recognize, analyze, and resolve complex data or operational problems.
• Work both independently and collaboratively in a team environment.
• Develop and document user requirements that support system enhancements.
• Interpret and apply policies, contract requirements, and regulations.
• Exercise sound judgment when making recommendations or decisions.
• Communicate effectively with technical and non-technical stakeholders.

Registrations, Licensure Requirements or Certifications:

• Leading SAFe 6.0 Agilist certification (preferred).

Initial Screening Criteria

Required:

• Three or more years of progressive experience 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.
• Three 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

• Out-of-State resumes will not be accepted. Selected candidate must be able to work onsite at the Austin office as needed.
• Interviewed candidates will be given an in-basket exercise.
• Job histories on your application/resume must demonstrate how you meet the initial selection criteria at a minimum.
• Some travel including occasional overnight trips may be needed.
• 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.

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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 Auditors 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 1-888-894-4747. 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.