Sr Data Analyst

Who We Are

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality affordable healthcare. Serving nearly 2 million members Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. Weve had a long-standing commitment to inclusion and equal healthcare access and outcomes regardless of background; its at the core of who we are. We value the rich mix of backgrounds perspectives and experiences of all of our colleagues which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve live and work.

We enjoy the important work we do every day in service to our members partners colleagues and communities. Learn more about who we are at Point32Health.

Job Summary

Job Description

DUTIES/RESPONSIBILITIES what you will be doing:

Data Management and Production:

• Independently manage and execute monthly APCD data submissions to state agencies for Tufts Health Plan and Harvard Pilgrim Health Care commercial and government products.
• Support RI EOHHS encounter data submissions including error analysis reconciliation remediation and endtoend submission support.
• Ensure compliance with regulatory requirements business rules data standards and technical specifications; document requirements and data logic as needed.
• Monitor and analyze encounter and APCD response files to identify rejections discrepancies and data quality issues; perform trend analysis and rootcause investigations and drive timely resolution.
• Lead prioritized data remediation efforts for encounter and APCD defects in collaboration with business and technical partners.
• Develop enhance and automate reconciliation and reporting processes using SQL SAS Alteryx and/or other analytical tools.
• Partner with IT and data engineering teams on enhancements and production issue resolution including requirements clarification issue investigation UAT and postimplementation validation.
• Support encounter and APCD data readiness for risk adjustment financial reconciliation actuarial reporting and regulatory audits.
• Serve as a subjectmatter expert for encounter and APCD data submission logic providing guidance and recommendations to crossfunctional teams.

Change Management and Process Improvement:

• Lead change management efforts related to stateissued specifications and internal enhancements impacting encounter and APCD data submissions.
• Perform endtoend issue analysis including rootcause identification documentation of business requirements implementation of data or process changes user acceptance testing (UAT) and postimplementation monitoring.
• Identify inefficiencies and improvement opportunities in monthly data submission reconciliation and tracking processes and drive continuous improvement initiatives.
• Monitor the effectiveness of implemented changes make necessary adjustments and ensure sustained regulatory compliance and operational stability.
• Develop and maintain submission dashboards and reconciliation reports using Tableau Excel and other reporting tools to track acceptance rates trends and performance metrics.

Collaboration and Stakeholder Management:

• Collaborate closely within the Risk Adjustment department and with crossfunctional partners including Claims Member Operations Information Technology and Provider Information to ensure data submission processes and enhancements are effectively implemented and maintained.
• Partner with IT to support timely resolution of production issues ensuring alignment between business requirements and technical solutions.
• Engage with external stakeholders including state agencies their consultants vendor data management teams and industry trade associations to stay informed of regulatory updates policy changes and evolving submission requirements.
• Communicate findings risks and recommendations clearly to management and stakeholders to support informed decisionmaking.

Administration:

• Attend internal and external (stateled) meetings; document key decisions; and track and manage followup actions through completion.
• Develop maintain and update business policies procedures and knowledge repositories to support consistent operations effective onboarding and audit readiness.

QUALIFICATIONS what you need to perform the job

Education

• Required: Bachelors degree required; masters degree preferred.
• Bachelors degree in health informatics information technology data management or a related discipline.

Experience

• Required: 57 years of experience in progressively responsible analytical and data management roles.
• Prior experience in the healthcare or health insurance sector (e.g. health plan provider group healthcare IT or auditing firm) and/or experience working with large datasets in a technical capacity.
• Experience developing maintaining and updating detailed policies and procedure documentation.
• Understanding of claims systems provider data and Medicaid Medicare and commercial products preferred.
• Prior experience with regulatory data submissions including AllPayer Claims Database (APCD) submissions a plus.

Skill Requirements

• Expertise in data management and controls IT processes and analytical tools; comfortable working with large datasets from disparate sources and identifying meaningful patterns and trends.
• Advanced technical skills in SQL and proficiency in Microsoft Excel.
• Experience with database systems such as Teradata and Oracle
• Experience with SAS Alteryx Databricks Tableau and knowledge of Xand 835 EDI transactions a plus.
• Demonstrated ability to manage multiple projects simultaneously in a complex fastpaced environment.
• Demonstrated maturity and professionalism with the ability to navigate complexity ambiguity and incomplete information.
• Engaged critical thinker who is organized detailoriented resourceful and selfmotivated; able to work independently and collaboratively.
• Strong verbal written and interpersonal communication skills with the ability to influence without authority and work effectively with internal and external stakeholders.
• Teamoriented resilient flexible and committed to highquality processes and outcomes.
• Ability to quickly learn and adapt to new technologies and applications.

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements e.g. lifting travel):

• This is a hybrid role with an expectation of one day per week onsite at the Canton MA office.
• Must be able to work under standard office conditions and from home as required.
• The role may require simultaneous use of a telephone or headset and a PC/keyboard as well as sitting for extended periods of time.
• Work may require multiple applications or documents to be open across multiple monitors simultaneously for analytical purposes.
• May be required to work additional hours beyond the standard work schedule as business needs dictate.

DISCLAIMER

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Salary Range

Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors including the scope and complexity of the role; the skills education training credentials and experience of the candidate; as well as internal equity. 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

• Employer-paid life and disability insurance with additional buy-up coverage options

• Tuition program

• Well-being benefits

• Full suite of benefits to support career development individual & family health and financial health

For more details on our total rewards programs visit welcome all
All applicants are welcome and 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