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 serves as a subject matter expert in encounter reporting and works closely with the Risk Adjustment Department to support the completeness, accuracy, and integrity of data used for reimbursement, regulatory compliance, and quality reporting. The position works cross-functionally with Claims, Enrollment, Provider Operations, Information Technology, Compliance, and Risk Adjustment teams to identify data quality issues, investigate reporting discrepancies, and improve processes. It also provides mentorship, project leadership, and operational guidance to support succession planning for a future leadership role within Encounter Reporting.
Requirements
- College degree in computer science, engineering, management information systems, or a related discipline; other degrees will 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 of relevant healthcare or health insurance applications.
- Permanent work authorization in the U.S.; 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 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.
- Analyze and support Interoperability data streams.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
