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24 May 2024

Full-Time Business Systems Analyst – Claims

Oregon Health Authority – Posted by Oregon Health Authority Salem, Oregon, United States

Job Description

Do you have experience applying data systems expertise to operationalize policies and programs that seek to ensure equitable access and high quality health care services and supports? Are you enthusiastic about analyzing data to create solutions and ensuring the efficiency of information systems through research and data testing for Oregon Health Plan members? We look forward to hearing from you!

Work Location: Salem/Marion, Oregon; hybrid position

What you will do!

This position serves as a business analyst focused on identification, solution design and resolution of Medicaid claims-related work within the Medicaid Management Information System (MMIS). This position will focus on issues related to claims adjudication within the MMIS, including research of claims and how they are processing within the system. Additionally, this position will be responsible for testing change requests for the MMIS that have a claims subsystem impact.

This position also participates and collaborates with multiple business partners across the Oregon Health Authority (OHA), Oregon Department of Human Services (ODHS) and various shared services programs to find resolution for outstanding claims issues.  This position requires thorough research and identification of various claim types in the MMIS and will also at times advise agency leadership and business partners of recommended changes or direction that help to meet the expectations of the agency in serving Oregonians who receive Medicaid services. This position also requires knowledge of both state and federal rules regarding Medicaid claims payments and all stages of Medicaid claims processing.

The position also has responsibility to give oversight and collaborative work in the Electronic Data Management System (EDMS). This position will also work in a cross-collaboration manner to help address other MMIS system issues and impacts, as needed. The claims business systems analyst serves as part of the Business Information Systems Section and specifically within the MMIS Business Services Unit.

OHA values service excellence, leadership, integrity, health equity and partnership and has a strategic goal to end all health inequities by 2030.

What’s in it for you?
We offer exceptional medical, vision and dental benefits packages for you and your qualified family members, with very low monthly out-of-pocket costs. Try this free virtual benefits counselor by clicking here: https://www.oregon.gov/oha/pebb/pages/alex.aspx

  • Paid Leave Days:
    • 11 paid holidays each year
    • 3 additional paid “Personal Business Days” each year
    • 8 hours of paid sick leave accumulated every month
    • Progressive vacation leave accrual with increases every 5 years
  • Pension and retirement programs
  • Optional benefits include short-term disability, long-term disability, deferred compensation savings program, and flexible spending accounts for health care and childcare expenses.
  • Click here to learn more about State of Oregon benefits.


Minimum Qualifications

Any combination of experience and education equivalent to five years professional-level evaluative, analytical and planning work.

Example: A Bachelor’s Degree in Business or Public Administration, Behavioral or Social Sciences, Finance, Political Science or any degree demonstrating the capacity for the knowledge and skills; and two years professional-level evaluative, analytical and planning work.

Desired Attributes

  • Experience developing, implementing policies and programs at the community, state, and/or national level.
  • Knowledge of health services delivery systems, particularly the Oregon Health Plan/ Medicaid administration in Oregon, and experience in working with Community Mental Health Programs, Behavioral Health Service Providers, Coordinated Care Organizations or other managed care entities.
  • Knowledge of the Medical Assistance program policies and procedures.
  • Knowledge of Medicaid Management Information System (MMIS) relevant functions, processes, and interfaces.
  • Knowledge of information systems development and implementation processes.
  • Knowledge of quality improvement methodologies and metrics within the context of health policy, health systems, and health care delivery settings.
  • Strong communication skills across a variety of forms.
  • Ability to demonstrate advanced Microsoft Excel, Word, PowerPoint and Outlook skillset; and skilled use of collaboration tools such as Microsoft Teams, SharePoint, and Smartsheet.

Salary Range: $4998 – $7647

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How to Apply

Complete the online application at oregonjobs.org using job number REQ-157569   Application Deadline: 06/02/2024

Job Categories: Equal Opportunities. Job Types: Full-Time. Salaries: 60,000 - 80,000.

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