Senior Data Analyst: Medicaid

Canton, MA

Full-time

Job Description

DUTIES/RESPONSIBILITIES – what you will be doing (top five):

Data Submission Integrity

• Support Medicaid manager across a range of activities, including monthly encounter data submission to the Executive Offices of Health and Human Services (MassHealth) and other States or Federal agencies
• Monitor ongoing encounter data 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 implementation of enhancements and timely resolution of production issues pertaining to state government and risk adjustment data submission, including issue investigation, business requirements, user acceptance testing and post implementation monitoring

Reporting and Data Management

• Use Tableau/Cognos/Excel to create a monthly submission dashboard and run submission reconciliations to effectively track acceptance rates and submission trends
• Create various reconciliations and adhoc reports
• Use SAS to extract and transform data to create reports from multiple sources
• Assist with the implementation of new program vendors, including data file transfers and reviews of internally received files for completeness, reasonability, and accuracy

Collaboration with Internal / External Stakeholders

• Collaborate effectively with risk adjustment leadership and with 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 remain up to date with changes and updates from EOHHS and other state agencies.
• Effectively communicate regulatory updates to team and department leadership, escalate risks appropriately

Analytics

• Conduct ad hoc analyses specific to risk score trends, data/claims submissions and program performance to support risk adjustment analytics; deliver timely and accurate information to contracted provider groups
• Perform data analytics to support ongoing and upcoming risk adjustment initiatives

Administration

• Support the creation and management of business policies and procedures and knowledge repositories for the department as needed

Requirements

QUALIFICATIONS – what you need to perform the job

EDUCATION, CERTIFICATION AND LICENSURE:

• Bachelor’s degree required, background in health informatics, business analysis programming, IT, finance, quantitative techniques, or a related discipline.
   

EXPERIENCE (minimum years required):

• 3-5 years of experience in progressively responsible analytical data management roles in a complex operational setting or consulting role.
• Previous experience working in the healthcare / health insurance sector either for a health plan, provider group, healthcare IT / management consultancy or auditing firm and/or experience working with large data sets in a technical capacity.
• Understanding of claims systems, provider information, and Medicaid/Medicare preferred.

SKILL REQUIREMENTS:  

• Expertise in SAS Enterprise Guide/ SAS Base and SQL/ProcSQL
• Experience with database software and reporting tools such as SQL Server, Oracle, and Cognos
• Expertise in data management and controls, IT processes, and utilizing analytical tools
• Comfortable working with large data sets from disparate sources, and able to identify relevant patterns and trends
• Experience with Alteryx, Cloudera, and Tableau is a plus
• Proficient in Microsoft Excel, PowerPoint, and Word
• Experience developing and updating detailed documentation of policies and procedures
• Engaged, critical thinker, organized, detail-oriented, resourceful, and self-motivated
• Must possess maturity, a high degree of professionalism and be able to deal with complexity and uncertainty and/or business decision ambiguity in the face of incomplete information
• Strong interpersonal and communication skills with an ability to work collaboratively with both internal and external stakeholders

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.

What we build together changes our customer's health for the better.  We are looking for talented and innovative people to join our team.  Come join us!

Please note: As of January 18, 2022, all employees — including remote employees — must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.