Sr Data Analyst Risk Adjustment
Sr Data Analyst Risk Adjustment
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1 Vacancy
Job Description
Who We Are
Point32Health is a leading health and wellbeing organization delivering an everbetter personalized health care experience to everyone in our communities. At Point32Health we are building on the quality nonprofit heritage of our founding organizations Tufts Health Plan and Harvard Pilgrim Health Care where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.
We enjoy the important work we do every day in service to our members partners colleagues and communities. To learn more about who we are at Point32Health click here.
Job Summary
Under the supervision of the Director of Data and Reporting this individual will be responsible for supporting critical data submission functions for the Risk Adjustment Department (RAD) including submissions to CMS and state agencies. The individual will handle internal data reconciliations and data transfers between Point32Health and external stakeholders such as vendors and provider organizations.This role requires strong analytical skills and the ability to synthesize large data sets and complex information into key insights. The individual will work effectively across business areas and often lead collaborative projects. They will need to follow complex business processes consider options when problems arise and identify and escalate issues appropriately.
Key Responsibilities/Duties what you will be doing
Data Submission Integrity
- Support the director across a range of activities including monthly encounter data submission to the Executive Offices of Health and Human Services (RI and MA) CMS and APCD (AllPayer Claims Database) submissions to state agencies.
- Monitor ongoing encounter data/APCDs response files to identify and address discrepancies in a timely manner.
- Review monthly error reports perform trend analysis investigate critical errors and work with the appropriate business area on resolution.
- Enhance and automate existing reconciliation and reporting code using advanced SAS and/or SQL skills.
- Interface with IT for the implementation of enhancements and timely resolution of production issues pertaining to state government and risk adjustment data submissions including issue investigation business requirements user acceptance testing and postimplementation monitoring.
Reporting and Data Management
- Use Tableau Cognos and Excel to create monthly submission dashboards and run submission reconciliations to effectively track acceptance rates and submission trends.
- Create various reconciliations and ad hoc reports.
- Use SAS to extract and transform data to create reports from multiple sources.
- Assist Strategy and Operations team with the implementation of new program vendors including data file transfers and reviews of internally received files for completeness reasonableness and accuracy.
- Establish and manage data transfer methods with vendors including working with IT to set up and manage secure file transfer sites for vendors that support our risk adjustment programs.
Collaboration with Internal/External Stakeholders
- Collaborate effectively within risk adjustment department and other internal stakeholders including Claims Member Operations Information Technology and Provider Information to ensure that process enhancements and submission mechanisms are maintained and monitored.
- Collaborate with federal agencies vendor data management staff and industry trade associations to stay up to date with changes and updates from EOHHS and other state agencies.
- Effectively communicate regulatory updates to the team and department leadership and escalate risks appropriately.
Data Analysis
- Conduct ad hoc analyses specific to risk score trends truncation report data/claims submissions and program performance to support risk adjustment analytics; deliver timely and accurate information to contracted provider groups.
- Create compile and format presentations for a variety of audiences including supporting worksheets graphics and supplemental documents.
Administration
- Attend meetings document key decisions manage follow up actions as necessary.
- Serve as department point of contact for various internal and external initiatives including interdepartmental projects across Point32Health business lines.
- Create and manage business policies and procedures and knowledge repositories for the department as needed.
Qualifications what you need to perform the job
EDUCATION CERTIFICATION AND LICENSURE:
- Bachelors degree required preferably in related field such as health informatics business analysis IT finance decision modeling.
EXPERIENCE (minimum years required):
- Three to five years of experience in analytical roles in the health care or health insurance sector either for a health plan provider group healthcare IT / management consultancy or auditing firm.
- Understanding of claims systems provider information Medicaid/Medicare and/or experience working with large data sets preferred.
SKILL REQUIREMENTS:
- Engaged critical thinker organized detailoriented resourceful and selfmotivated.
- Comfortable working with large data sets from disparate sources and able to identify relevant patterns and trends.
- Expertise in SAS Enterprise Guide/ SAS Base and SQL/ProcSQL (SAS certification preferred).
- Experience with database software and reporting tools such as SQL Server Oracle and Cognos.
- Experience with Alteryx Cloudera and Tableau is a plus.
- Proficient in Microsoft Excel PowerPoint and Word.
- Strong interpersonal and communication skills.
- Ability to work collaboratively with both internal and external resources.
- Ability to take responsibility prioritize tasks and follow through to completion.
WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements e.g. lifting travel):
- Must be able to work under normal office conditions and work from home as required.
- Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
May be required to work additional hours beyond standard work schedule
Compensation & Total Rewards Overview
As part of our comprehensive total rewards program colleagues are also eligible for variable pay. Eligibility for any bonus commission benefits or any other form of compensation andbenefits remains in the Companys sole discretion and maybe modified at the Companys sole discretion consistent with the law.
Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:
Medical dental and vision coverage
Retirement plans
Paid time off
Employerpaid life and disability insurance with additional buyup coverage options
Tuition program
Wellbeing benefits
Full suite of benefits to support career development individual & family health and financial health
For more details on our total rewards programs visit 32health/careers/benefits/
Commitment to Diversity Equity Inclusion Accessibility (DEIA) and Health Equity
Point32Health is committed to making diversity equity inclusion accessibility and health equity part of everything we dofrom product design to the workforce driving that innovation. Our Diversity Equity Inclusion Accessibility (DEIA) and Health Equity teams strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming events and an inclusion infrastructure play a role in how we spread cultural awareness train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals who will receive consideration for employment without regard to race color religion gender gender identity or expression sexual orientation national origin genetics disability age or veteran status.
Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact you may contact
Required Experience:
Senior IC
Employment Type
Full-Time
