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Operations Research Specialist (ORS/FS)

Company: State of Washington Health Care Authority
Location: Olympia
Posted on: November 8, 2019

Job Description:

SunIRef:it Operations Research Specialist (ORS/FS) State of Washington Health Care Authority 254 reviews - Olympia, WA $6,036 - $7,918 a month State of Washington Health Care Authority 254 reviews Read what people are saying about working here. Description Operations Research Specialist (ORS/FS) Who we are: The Washington State Health Care Authority (HCA) purchases health care for more than 2 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and, beginning in 2020, the School Employees Benefits Board (SEBB) Program. Our agency is committed to whole person care, integrating physical health and behavioral health services for better results and healthier residents. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost. The Financial Services Division works with a variety of external stakeholders and customers to provide financial services and agency-wide financial management for behavioral health, Medicaid, and PEBB, including managing the operating budget, forecasting, accounting, provider rates development, hospital finance, audit and compliance, and other critical functions for HCA. This division maintains close working relationships with agency program, policy, and clinical divisions to ensure financially sound implementation and monitoring of program strategies. It is also accountable to the Governor and legislature in ensuring HCA operates within its overall agency budget. This position is the expert responsible for the design, development, implementation, and administration of complex databases and data technology solutions for all aspects of hospital finance. This position is the highest level of authority for Washington State's Hospital Safety Net Assessment (HSNA). The HSNA is a statewide provider assessment and payment program of approximately $360 Million dollars. This position is responsible for reporting to HCA Management, legislative staff, and the Washington State Hospital Association, ensuring changes to the HSNA are modeled accurately and issues are communicated and resolved. The stakeholders for the HSNA program are a politically and financially influential group, requiring precision and detail regarding all areas of the HSNA program. Some of the tasks this position will perform: Design, develop, and maintain databases and data processes related to the Hospital Safety Net Assessment Program. HSNA database program manager. Design, develop, and maintain large volume databases and data modeling related to the HSNA program using Procedural Language - Structured Query Language (PL/SQL) and Transact- Structured Query language (T-SQL) in PL/SQL Developer, Microsoft SQL Server Management Studio, and Microsoft Visual Studio software applications. Extract, Transform and Load Medicaid Managed Care premium data from the HCA MMIS data warehouse to the Hospital Finance database on a monthly basis using PL/SQL and T-SQL and Visual Studio SSIS packages. Design, develop, deploy, and maintain SQL Server Integration Services Packages that facilitate assessment and payment information to support the HSNA program Design, develop, deploy, and maintain SQL Server Reporting Services Packages that facilitate the assessment and payment information to support the HSNA program. Prepare financial and/or Medicaid enrollment transaction analyses and comprehensive reports regarding HSNA methodologies with findings and recommendations to executive management such as forecasting accrual information to determine prospective payments based on historical data and tracking expenditures for the various enrollment programs and/or overall spending for budget purposes. Execute data extracts and perform data validity checks for the purpose of determining accurate per member per month premium enhancement amounts used for the HSNA managed care payment process in coordination with actuarial consultants to ensure managed care premium levels support legislatively mandated payments related to the HSNA program. Design, develop and maintain databases and processes related to Professional Services Supplemental Payment (PSSP) and Provider Access Payment (PAP) Methodology and Payment Integrity. Design, develop, and maintain tables and processes for data formats and transmission of cost reporting information that conforms to federal requirements to include billable units of service, charges, allowable and total costs, and payments and fee schedule amounts for each combination of CPT code, CPT modifier, service setting and provider type ("CPT code combination") to accurately track provider cost reporting information used to determine average costs per transport to ensure proper supplemental payments for transport services provided. Perform data validity tests of the ODS claims data in relation to provider submitted cost report information to ensure that the cost-reported provider data ties directly to the providers' accounts receivable systems such as properly identifying transport claims that should or should not be considered for supplemental payment due to either billing issues or program requirements for client eligibility. Design, develop and maintain databases and processes related to the Airlift Services supplemental Payment (ASSP) Methodology and Payment Integrity. Design, develop, and maintain large volume databases and data modeling related to the airlift services program using Procedural Language - Structured Query Language (PL/SQL) and Transact- Structured Query language (T-SQL) in PL/SQL Developer, Microsoft SQL Server Management Studio, and Microsoft Visual Studio software applications. What we have to offer you: Meaningful work with friendly co-workers who care about those we serve. A clear agency mission that drives our work and is person-centered. A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby. A great total compensation and benefit package. A healthy work/life balance, including alternative/flexible schedules and mobile work options. And we can't forget.....Free parking. Required Education, and Experience A Bachelor's degree in business or public administration, hospital administration, accounting, economics, statistics, mathematics, engineering, healthcare, finance or equivalent relevant field plus four years of experience in accounting, budgeting, program management or program analysis Three years of consultative, administrative, or supervisory experience in information technology analysis, system maintenance, or troubleshooting/problem resolution, or analyzing, designing, or programming computer systems applications or databases Database programming - Proficiency in database programming logic and creating relational databases using either SAS or SQL software OR A Master's degree in business or public administration, hospital administration, accounting, economics, statistics, mathematics, engineering, healthcare, finance or equivalent relevant field plus two years of experience in accounting, budgeting, program management or program analysis AND Data Analysis - Experience working with large volume Managed Care encounter and or Medical claims data in requesting, collecting, importing and modifying raw data. Experience in analyzing and reviewing data integrity OR A Bachelor's degree in business or public administration, hospital administration, accounting, economics, statistics, mathematics, engineering, healthcare, finance or equivalent relevant field plus two years of experience in accounting, budgeting, program management or program analysis; AND Data Analysis - Experience working with large volume Managed Care encounter and or Medical claims data in requesting, collecting, importing and modifying raw data. Experience in analyzing and reviewing data integrity AND Certification as a Certified Public Accountant (CPA) Years of experience can substitute for a degree on a year for year basis. For example, four years of professional experience in the financial, analytical, or accounting fields are equivalent to a Bachelor's degree. An individual with 4 years of experience in financial, analytical or accounting fields is equivalent to a Bachelor's degree. An individual without a Bachelor's degree must have at least 7 years of experience to meet the educational and experience requirement: 4 years to meet the educational requirement and the other 3 years to meet the experience requirement. Desired Education, Experience and Competencies Working experience with International Classification of Diseases (ICD) diagnosis codes, ICD operating procedures, and other clinical classification software Working experience with Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) coding How to : To apply for this position you will need to complete your profile on **************, and attach the following items: A current state application profile using ************** A letter of interest with specific language on why you are interested in the Operations Research Specialist position. No more than two pages in length. A current resume that is no more than two pages in length. A list of contact information for three professional references, including at a minimum one current or previous supervisor. If you have questions about the process, or need reasonable accommodation, please contact Sidra Fields, before the posting closes. The candidate pool certified for this recruitment may be used to fill future similar vacancies for up to the next six months. Washington State is an equal opportunity employer. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may call the Human Resources Office at ************ or email *********************** * Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment but will be considered in determining the applicant's suitability and competence to perform in the position. * State of Washington - Just posted report job - original job

Keywords: State of Washington Health Care Authority, Olympia , Operations Research Specialist (ORS/FS), Accounting, Auditing , Olympia, Washington

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