Job ID:
Business Analyst
Job Description
Brief Duty Description:  Identifies, initiates and assures the quality installation of system functionality and change/enhancement projects for the prescription drug claims in the PBMS, BIDM and Colorado interchange; including all claims and capitation related system changes, pricing, benefit plans, reference codes, and interface file exchanges. Drafting configuration change management (CCM) documents and reviewing test cases on a large scale related to the PBMS reprocurement and implementation. Coordinates with pharmacy staff and acts as the project manager for tasks relating to designing or enhancing systems, diagnosing system issues, analyzing test results, and coordinating system procedures related to pharmacy claims processing. Arranges policy staff attendance at system requirement change reviews, system design reviews, test case reviews, and project status reviews when necessary. Serves as the liaison between the Department, PBMS staff, Fiscal Agent staff, and other contractor staff to translate new or revised processes, and coordinates with other sections in the Department to implement system changes.   System Analysis: 20% Brief Duty Description:  Analyzes the business need of projects by researching federal and state regulatory procedures for prescription drug claims processing, pricing and rebate. Draft system requirements for new and revised processes to integrate pharmacy benefits and programs into various systems and collaborate with other system analysts and vendors in the development, validation process and review of technical specifications. Review test plans, technical specifications, test results and provide system documentation for new and revised processes. Assures Medicaid Management Information System (MMIS) and BIDM system changes align with the PBMS functionality and maintains a system of checks and balances to assure that data is consistent, complete and accurate. Works with providers and managed care organizations related to claim submission in the interchange and PBMS and works with pharmacy staff to ensure that PDL, Appendix P and Appendix X updates are properly translated into the relevant systems. Assists with the system functions for drug rebate processing.   System Testing:20% Brief Duty Description:  Coordinates testing for the PBMS, BIDM, Colorado interchange and relevant subsystems related to new or revised processes. Researches testing topics and validates that test results meet the identified functional requirements for the change request. Coordinates with program staff and system staff to review test results to ensure that the system functions as intended. Analyze test results for defect findings and define the remediation process for the test environment while working with the system vendor to ensure that the defects are corrected, fully retested and approved for production. Create and document test scenarios according to the business requirements. Provide status report on testing to relevant staff and vendors.   Policy Impact Analysis:15% Brief Duty Description:  Evaluates new and existing system functionality to ensure alignment with program policy requirements and regulations. Provides approval, disapproval or modification of design documents in consultation with other pharmacy staff. Assesses the impact of the design document across systems by requesting system testing to evaluate effect on other system areas. Provides support with end user testing as needed. Examines and analyzes federal and state publications, including proposed rules and laws, to determine if changes are needed for the PBMS, BIDM or Colorado interchange systems and works with system analysts to formulate the required system change and associated test cases necessary to implement the change. Updates the CMS required Advance Planning Document (APD) for review and approval when necessary.   Operational Monitoring:5% Brief Duty Description:  Monitors and assures quality of all assigned projects with Department staff, the fiscal agent, PBMS, BIDM and other vendors to ensure that system changes meet the intent and purpose of the project requirements. Track all assigned system change requests for critical and collaborative change testing needs. Responds and provides technical support to inquiries from Department policy staff, Fiscal Agent staff, CMS staff and others related to assigned subsystems and special projects.