Information Management Analyst lll - Growing Healthcare Org!

Fallon Health•Worcester, MA

4d•Remote

About The Position

Fallon Health is a healthcare company committed to providing equitable, high-quality, coordinated care, and is recognized nationally for its member experience, service, and clinical quality. Founded in 1977 in Worcester, Massachusetts, Fallon Health embraces diversity and inclusion. The company's mission is to improve health and inspire hope, aiming to be the leading provider of government-sponsored health insurance programs in the region. This specific role, Information Management Analyst III, Encounter Reporting & Risk Adjustment Support, is crucial for leading the analysis, validation, reconciliation, and submission of healthcare encounter data to regulatory entities like the Commonwealth of Massachusetts. The position requires a subject matter expert in encounter reporting who will collaborate with the Risk Adjustment Department to ensure data integrity for reimbursement, compliance, and quality reporting. This role involves cross-functional collaboration with various departments including Claims, Enrollment, Provider Operations, IT, Compliance, and Risk Adjustment to identify and resolve data quality issues and implement process improvements. Additionally, the role is designed to provide mentorship and project leadership to prepare an individual for a future leadership position within Encounter Reporting. This position requires permanent work authorization in the U.S. and does not offer visa sponsorship or accept candidates on OPT/CPT. Hiring is restricted to residents of MA, CT, RI, NH, NY (excluding Burroughs), FL, GA, TX, NJ, ME, and VT.

Requirements

College degree in computer science, engineering, management information systems or related discipline. Other degrees will be considered with appropriate background and experience.
5+ years of healthcare data analytics, encounter reporting, claims reporting, or regulatory reporting experience.
5+ years applied technical skills related to SQL, data analytics, data warehousing techniques, visualization tools, project management, requirements elicitation.
5+ years’ experience providing application support or configuration of relevant healthcare / health insurance applications.
Permanent work authorization in the U.S.
Residency in MA, CT, RI, NH, NY (not Burroughs), FL, GA, TX, NJ, ME, VT.

Responsibilities

Monitor encounter submission performance, acknowledgments, rejections, and acceptance rates.
Analyze and resolve encounter data errors and submission failures.
Ensure compliance with Massachusetts reporting requirements, submission specifications, and reporting deadlines.
Coordinate testing and validation activities for system implementations affecting encounter data.
Partner with the Risk Adjustment team to support diagnosis and encounter data accuracy.
Assist in identifying gaps in encounter submissions that may impact risk score accuracy.
Support CMS and internal audit activities related to diagnosis and encounter data validation.
Act as liaison between business teams, IT departments, vendors, and external agencies.
Translate business and regulatory requirements into reporting and technical specifications.
Lead issue resolution meetings involving encounter reporting and data quality concerns.
Participate in enterprise initiatives impacting healthcare data management and reporting processes.
Build leadership skills through project leadership and stakeholder management responsibilities.
Mentor junior analysts and new team members.
Review work products and provide quality assurance guidance.
Assist with prioritization of team workload and reporting schedules.
Lead special projects and continuous improvement initiatives.
Provide subject matter expertise during audits, implementations, and strategic initiatives.
Analysis and support of the Interoperability data streams.