Information Management Analyst lll
About The Position
The Information Management Analyst III, Encounter Reporting & Risk Adjustment Support, leads the analysis, validation, reconciliation, and submission of healthcare encounter data to the Commonwealth of Massachusetts and other regulatory entities. The role is a subject matter expert in encounter reporting and works with the Risk Adjustment Department to support complete, accurate, and reliable data for reimbursement, regulatory compliance, and quality reporting. The analyst collaborates across Claims, Enrollment, Provider Operations, Information Technology, Compliance, and Risk Adjustment to identify data quality issues, investigate reporting discrepancies, and improve processes. The position also provides mentorship, project leadership, and operational guidance to support succession planning for a future leadership role in Encounter Reporting.
Requirements
- College degree in computer science, engineering, management information systems, or a related discipline; other degrees may be considered with appropriate background and experience.
- At least 5 years of healthcare data analytics, encounter reporting, claims reporting, or regulatory reporting experience.
- At least 5 years of applied technical skills related to SQL, data analytics, data warehousing techniques, visualization tools, project management, and requirements elicitation.
- At least 5 years of experience providing application support or configuration for relevant healthcare or health insurance applications.
- Permanent work authorization in the United States; visa sponsorship is not provided and candidates on OPT/CPT are not accepted.
- Must reside in one of the listed eligible states: MA, CT, RI, NH, NY (excluding the boroughs), FL, GA, TX, NJ, ME, or 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 Risk Adjustment to support diagnosis and encounter data accuracy and identify submission gaps that may affect risk score accuracy.
- Support CMS and internal audits related to diagnosis and encounter data validation.
- Act as liaison among business teams, IT departments, vendors, and external agencies.
- Translate business and regulatory requirements into reporting and technical specifications.
- Lead issue-resolution meetings about encounter reporting and data quality.
- Participate in enterprise initiatives affecting healthcare data management and reporting processes.
- Mentor junior analysts and new team members; review work products and provide quality assurance guidance.
- Assist with prioritizing team workload and reporting schedules.
- Lead special projects and continuous improvement initiatives.
- Provide subject matter expertise during audits, implementations, and strategic initiatives.
- Analyze and support Interoperability data streams.
- Build leadership skills through project leadership and stakeholder management responsibilities.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
