Business Systems Consultant IV

Business Systems Consultant IV

Salem, OR/ Remote

9 plus months

Client is seeking an experienced Business Systems Consultant with expertise in data system analysis and evaluation and advanced communication skills to provide project management support, data system evaluation and improvement support, including the documentation of improvement recommendations, business and technical requirements and test cases, and delivery of testing support in accordance with business, data security and regulatory requirements.

Background And Scope Of Project

HAL is a Medicaid analytical and reporting SQL database solution and environment managed by the MADI (Medicaid Analytics and Data Integration) Unit housed within the Office of Health Information Technology and Analytics Infrastructure, that exists within the Health Policy and Analytics (HPA) Division of the Oregon Health Authority (OHA).

Medicaid administrative data is primarily made up of 1) medical claims submitted by health providers and Coordinated Care Organizations (CCOs) to receive payment for health services delivered to patients enrolled in Oregon's Medicaid program, which is known as the Oregon Health Plan (OHP) and 2) Medicaid enrollment data from the OHA/ ODHS ONE eligibility system. The raw transactional data are stored in Oregon's Medicaid Management & Information System (MMIS). HA analysts typically access these data through a MMIS data warehouse solution called Decision Support and Surveillance Utilization Review System (DSSURS), or in the Health Analytics Library (HAL), where the raw Medicaid enrollment and utilization/ claim data are packaged differently into easier to analyze categories and groups for analysis. These analytical value-added elements are not present in DSSURS.

HAL contains Medicaid enrolment and claims data that is accessed by two main sets of users:
• OHA's Office of Actuarial and Financial Analysis (OAFA) team users, who use the data for setting of per-capita rates of reimbursement of health care services provided by Coordinated Care Organization (CCO's) to Oregon's Medicaid population, and various other financial analyses.
• Office of Health Analytics' reporting teams, who access Medicaid enrollment and claims data for the development of different enrollment and utilization analytical and data visualization products.

The HPA MADI unit wants to launch a HAL modernization project to analyze, identify and make improvements to the HAL analysis and reporting database solution. This project has the following objectives:
• Analyzing the existing HAL database solution and environment, identifying any refinements or rework to HAL architecture, dataflows, governance or management processes, and developing a roadmap for HAL future state.
• Reprogramming HAL ETL code, currently written in legacy SAS language, into SQL language, to prepare HAL for migrating to the OHA ODE (Oregon Data Environment) cloud Azure environment (NOTE: The migration to the cloud, expected to occur in the next 1-2 years, is out of scope for this project and will require working with OIS and other OHA teams)
• Gathering and documenting requirements, developing and testing other improvements to the HAL data logic, including:
• Updating claim data grouping categories used predominantly by the Office of Actuarial and Financial Analysis (OAFA) team for rate capitation analyses, to reflect updates Medicaid national coding standards.
• Performing other coding improvements needed by OAFA team users and other HAL users to improve analytical value and capabilities of HAL data or reflect changes in Medicaid eligibility, program, beneficiary and claim administrative coding– these types of improvements have accumulated over time and have reached a point in which they require a focused project and dedicated resources.

Tasks:

Contractor's Key Person Shall Work With Various OHA Program Areas And Business Teams And OIS Staff As Needed Performing The Following Tasks
• Provide project management support, such as writing project status and other written reports and presentations covering analysis and recommendations for agency project team/ project governance committee, communication materials, etc.
• Lead and perform HAL data system analysis and evaluation work, including:
• interviewing system users and system management teams to inquire about system issues and gaps,
• reviewing documentation and analyzing current HAL system/ environment, including data models, schemas and tables, data dictionaries, ETL's, system and database management processes, data quality, security, queries, reporting environment, etc.
• documenting existing data/system architecture, data flows, description of schemas, tables and fields
• identifying and describing current issues and areas for improvement,
• providing or developing system improvement reports and recommendations.
• documenting, prioritizing, and presenting improvement recommendations,
• developing a strategic roadmap for data system improvement efforts.
• Work with OHA project team members (PM, Client, DBAs, data analysts, architects) and HAL users to determine business/technical requirements, evaluate and recommend specific data design options
• Gather and document detailed system, data and integration requirements for HAL system improvements (e.g. changes to business rules, ETL code, HAL tables, new or updated OHG Medicaid claim code grouping categories, etc.)
• Develop test cases, scripts and test datasets.
• Perform system/ data testing, analyze and document test results.
• Develop or update data management standards and processes, to inform business area system improvement and deployment activities, and train OHA staff in the application and use of these standards and processes.
• Organize, develop and update system, process and training materials to help educate HAL users about data management best practices and usage of BI tools to analyze and report data stored in HAL.

Required skills and experience:
• Excellent written/ oral communication skills.
• Advanced data analysis skills.
• Analytical problem-solving skills.
• Working knowledge of SDLC.
• Proficient in the use of Microsoft Office suite tools.

In addition, the ideal candidate will have skills and experience in:
• Knowledge of Medicaid administrative data and eligibility requirements.
• Knowledge of project management principles.
• Business analysis techniques, especially in gathering and documenting business and technical requirements.
• Project management tools like Smartsheet.
• Attention to detail.

#TB_EN

Job #: 25-24140