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Fallon Health Healthcare Analyst II - Network Development Management - Hybrid Remote in Worcester, Massachusetts

Overview

About Fallon Health:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon delivers equitable, high-quality coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief Summary of Purpose :

Consults, designs, and produces provider data information/reporting to assist in business and network development to support key initiatives for senior leadership, provider network development and market research. Responsible for both production and adhoc reporting including required reports for governmentalagencies such as CMS, DOI and MassHealth. Responsible for analyzing member accessibility of current and prospective provider networks; including vendor requests and requests-for-proposal (RFP). Assists in the analysis, development and implementation of new product solutions in support of organizational growth.

Responsibilities

Job Responsibilities:

  • Prepares comprehensive data analysis using information from FCHP systems (including but not limited to, the Enterprise Data warehouse, Avenue, QNXT replicated service) in an accurate and timely fashion for internal and external customers. Uses querying and programming skills to develop production and ad hoc reports using both small and very large data sets. Reviews all reports and outputs for internal consistency and reasonableness.

  • Establishes and maintains positive, collaborative relationships with other Fallon departments such as IT, Quality, Sales, Finance, Government Programs, OSS, and Product Development. Consults with customers to actively engage them in defining their requests. Works collaboratively with peers to assist with areas of expertise. Completes ad hoc reporting as requested by internal customers, as needed.

  • Provide assistance on technical matters and acts as a significant information resource.

  • Responsible for developing/ maintaining reports for State and Federal agencies including DOI, MassHealth and Medicare Programs. Multiple reports produced and submitted on a monthly, quarterly, and annual basis to satisfy regulatory requirements.

  • Reviews the annual updates/specifications from State Agencies and modifies reports as necessary. This includes maintenance of databases for government agencies including required documentation.

  • Completes the reporting package and facilitates the State attestation concerning Fallon providers and the network.

  • Responsible for creating monthly reports for providers including accuracy review, addressing variance in reporting by provider and posting to EDI gateway.

  • Primary point of contact for contract management system selection and implementation. Responsible for completing the platform testing (specific to contracting).

  • Builds databases for provider tracking and reporting packages as requested by internal customers.

  • Develops clear documentation and training for NDM department to modify and run developed, canned reports.

  • Constantly works to identify opportunities for improvement in work process and reports.

  • Utilizes Quest Analytics software to produce detailed maps, network adequacy reports, Health Service Delivery (HSD) tables for CMS and member/employee’s accessibility to Fallon Health’s providers (PCP’s, Specialists, Hospitals, etc).

  • Participate in process improvement projects including but not limited to, RFPs. Collaborate with internal teams and external vendors to assess initial opportunity, prospective vendor collaboration, strategic development, implementation, and training.

Qualifications

Education:

BS / BA with coursework in computing programming / business / MIS or public healthcare preferred or related work experience

License/Certifications:

  • SQL Query – Certificate of Completion required

  • Advanced MS Excel – Certificate of Completion required

Experience:

  • 5+ years Business Data Analyst experience in health care, preferably in a managed care setting

  • Demonstrated expertise in business project management

  • Proficient in Data Analysis, SQL, Quest, Alteryx, Ipswitch, Business Objects and MS office including Access, Word and Excel.

  • Skilled in the ability to create, modify and execute moderate to advance queries.

  • Keen aptitude in analyzing, interpreting, and communicating outputs, including those of large data sets.

  • Capable of designing reporting outputs (with automation features) for all levels of the organization.

  • Minimum of 3 years’ experience in data integrity analysis.

  • Demonstrated experience in managing large projects from development to completion (including detailed documentation, acting as liaison with key areas and keen sense of innovation to accomplish initiatives).

  • Experience in using and analyzing large healthcare data sets and relational databases.

Fallon Health Vaccination Requirements:

To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022 all roles not designated as “Remote” require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Location US-MA-Worcester

Posted Date 1 month ago (11/4/2022 4:12 PM)

Job ID 7100

# Positions 1

Category Network Development

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