Agency/Division Information  

The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agency’s core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, and servant leadership. As part of the interview process, candidates may be required to attend an in-person interview at our Oklahoma City office. 

Position Purpose  

The purpose of this position is to support the integrity and effective operation of the Medicaid Management Information System (MMIS) by maintaining and monitoring reference file subsystems and ensuring alignment with OHCA policy as well as state and federal Medicaid regulations. This role analyzes healthcare coding structures and payment rules, evaluates system impacts of policy and regulatory changes, and collaborates with medical, policy, finance, provider engagement, and claims units to ensure accurate claims processing and program compliance. The position also conducts research, performs operational and utilization analysis, supports system modifications and special projects, and provides guidance and training to internal staff and external partners to promote consistent interpretation and implementation of Medicaid program policies. 

Principal Activities May Include:  

• Maintains the OHCA OKMMIS reference file subsystem which includes:  ICD-/CM and PCS diagnosis and surgical procedure codes, CPT, revenue and HCPCS, etc. files.  Ensures that all files reflect appropriate rules included in OHCA policy as well as appropriate state and federal policies.  

• Using multiple methods of oversight monitors the integrity of the reference file (e.g., report generation and review of associated documentation).   

• Researches and investigates special areas of concern. Works with OHCA Medical Professional, Finance and Policy units to reviews law and regulations and makes recommendations for changes to the Medicaid program.  

• Interfaces with OCHA staff regarding OKMMIS issues, changes, problems or updates.  Conducts frequent evaluations of OKMMIS issues and provides problem solving assistance to ensure that the payment mechanisms of OHCA comply with OHCA policy and all state and federal regulations.   

• Interfaces with OHCA Provider Engagement and Claims Adjudication Unit.  Interpret policy and assist in problem solving.  Provides training concerning new and changing programs.  

• Researches and investigates special areas of concern. Reviews law and regulations and makes recommendations for changes to the Medicaid program.  

• Performs a variety of routine analytical tasks and special projects related to operational and utilization performance and/or analysis for the Medicaid program.  

• Coordinates in the completion of special projects/studies including report generation, review and detailed recommendations.   

• Coordinate with agency staff and fiscal agent staff to assure appropriate outcomes are met, by monitoring inter-agency information system changes and modifications for project development, implementation and deadlines.  

• Provides training assistance to other agencies, providers, clients and agency staff, with interpretation of existing policies, development of new policies, and claims processing issues.  

• Represents OHCA at meetings, trainings, task forces, or conferences. 

• Other duties as assigned.  

Education and/or Experience:  

• Bachelor’s degree in public health, health information management or closely related field and two years of professional experience in healthcare data analytics, healthcare information systems, and/or healthcare program operations OR 

• An equivalent combination of education and experience.  

The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate.  All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405-522-7335.  

 Notice to applicants:

Please add OHCAHR@okhca.org  to the address book or “safe-senders” list in your email.  All correspondence will come from this address.  Be sure to check your junk folder.  If you have questions about the status of your application, you can contact the HR team at 405-522-7093.

Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.

Current State of Oklahoma employees must apply for open positions internally through Workday Jobs Hub.