Manager, Reporting and Analytics – Medicare Advantage

Point32Health•Canton, MA

2d•$122,498 - $183,748•Hybrid

About The Position

Point32Health is hiring a Manager, Reporting and Analytics – Medicare Advantage to oversee Medicare Advantage risk adjustment and All-Payer Claims Database (APCD) data reporting and submissions. Reporting to the Director of Risk Adjustment Reporting and Analytics, the Manager will ensure the accuracy, completeness, integrity, and compliance of submissions to CMS and six state agencies, while supporting risk score accuracy and revenue performance across Medicare Advantage products. The role combines analytical, technical, business, and leadership responsibilities. It requires working across areas including Member Operations, Provider Information, Claims, IT, Actuarial, external vendors, CMS, and state agencies. The Manager will partner with IT on data architecture, data lineage, data flow analysis, solution design, root-cause investigations, implementation planning, and quality assurance. The position also leads a team of 3–4 senior analysts and data leads, providing coaching, mentorship, performance management, and professional development. This is a hybrid role, with an expectation of one day per week onsite at the Canton, Massachusetts office. The salary range is $122,498.40–$183,747.60 annually. Colleagues are also eligible for variable pay, and the company offers a comprehensive total rewards package.

Requirements

Bachelor’s degree required.
7–10 years of progressively responsible experience in analytical roles.
Leadership, data management, and IT data governance experience in a complex operational setting or health plan environment.
Experience with data governance, data architecture, data lineage, data quality controls, and reporting.
Healthcare payer, provider, or consulting experience, including team leadership and stakeholder management.
Experience in risk adjustment data analytics, reporting, or process improvement in healthcare or health insurance for a health plan, provider group, or management consultancy.
Experience managing a team, and experience with process improvement and project management.
Working knowledge of healthcare claims, member, and provider data; data systems; and financial reporting.
Ability to navigate complex business, operational, and regulatory environments and collaborate with internal and external stakeholders.
Strong verbal and written communication skills, including presentations to individuals and small and large groups.
Excellent judgment, critical thinking, problem-solving, and decision-making abilities.
Strong process management, process improvement, and project management skills, including handling multiple priorities, improving operational efficiency, and meeting competing deadlines.
Expertise in data management, data governance, internal controls, and IT data processes; ability to work with large, complex datasets from disparate sources and use analytical tools to identify patterns, trends, and actionable insights.
Strong experience with SQL (Oracle, SQL Server, Teradata), SAS, Databricks, Alteryx, Tableau, and analytical, database, and reporting tools.
Advanced proficiency in Microsoft Excel, PowerPoint, and Word.
Experience developing and maintaining detailed documentation of policies, procedures, controls, and analytical processes.
Must be able to work under normal office conditions and from home as required.
Work may require simultaneous use of a telephone/headset and PC/keyboard, extended sitting, and use of multiple applications or documents across multiple monitors.
May be required to work additional hours beyond the standard work schedule.

Nice To Haves

Experience with CMS, Medicare Advantage risk adjustment, EDS/EDPS, APCD submissions, state agencies, healthcare regulatory programs, health insurers, or medical provider systems.
Vendor management experience.

Responsibilities

Plan, execute, implement, and monitor Medicare Advantage and APCD data submissions and reporting efforts.
Review the effectiveness, accuracy, and compliance of claims, supplemental data, APCD submission processes, infrastructure, and reporting; recommend and implement enhancements.
Oversee data controls, dashboard reporting, routine reconciliations, and management updates; present Medicare Advantage risk adjustment issues, business updates, and performance metrics.
Collaborate with Actuarial on Medicare Advantage analytics, program and provider-level analyses, and targeting.
Coordinate with Claims, Membership Operations, Provider Information, external vendors, IT, and other stakeholders to develop, maintain, and monitor process improvements and data management mechanisms.
Lead communications, coordination, issue resolution, and compliance activities with six state agencies for timely, accurate APCD submissions.
Contribute to strategic planning and annual risk adjustment business plan development; participate in CMS and industry calls and monitor regulatory and technical specification changes.
Serve as the organization's subject matter expert on EDS/EDPS and APCD reporting requirements in internal work and interactions with CMS and state agencies.
Oversee CMS EDS/EDPS submissions for Massachusetts HMO, PPO, SCO, and Unify products and Connecticut HMO and PPO products, as well as APCD submissions to six state agencies.
Review CMS errors, outliers, and data quality findings and coordinate remediation, corrective actions, or appropriate justification with internal and vendor partners.
Coordinate required reviews and sign-offs for EDS/EDPS and APCD submissions; oversee supplemental submissions and deletes, including acceptance, submission, reconciliation, and tracking.
Develop internal capabilities and/or work with vendors on data optimization; maintain opportunities for data quality, operational efficiency, and submission enhancements.
Participate in corporate projects and strategic initiatives, including development, evaluation, and presentation of business cases related to EDS/EDPS, APCD, and data optimization.
Review CMS HPMS memoranda and regulatory guidance, identify operational and reporting impacts, and coordinate timely implementation of required actions and compliance obligations.
Coordinate with vendors and Actuarial teams to ensure accurate, complete data supports valuation, forecasting, targeting, and performance analysis.
Manage and perform analytics for ongoing and emerging risk adjustment initiatives; build, maintain, and enhance EDS/EDPS tieback processes and reporting for actuarial valuation.
Develop executive-level reports, dashboards, and PowerPoint presentations communicating reconciliations, findings, risks, opportunities, and recommendations.
Lead a team of 3–4 senior analysts and data leads, providing coaching, mentorship, performance management, and professional development.
Review analytics, reporting, documentation, and technical deliverables for quality, accuracy, and alignment with business objectives; maintain documentation to departmental standards, policies, and procedures.

Benefits

Medical coverage
Dental coverage
Vision coverage
Retirement plans
Paid time off
Employer-paid life insurance with additional buy-up coverage options
Employer-paid disability insurance with additional buy-up coverage options
Tuition program
Well-being benefits
Variable pay eligibility
Benefits supporting career development, individual and family health, and financial health