Manager, Reporting and Analytics – Medicare Advantage

Point32Health • Canton, MA

3d • $122,498 - $183,748 • Hybrid

About The Position

The Manager, Reporting and Analytics – Medicare Advantage applies advanced business, analytical, technical, and leadership skills to ensure the accuracy, completeness, and integrity of risk adjustment data submissions to CMS. The role supports risk score accuracy and revenue performance across Medicare Advantage products, and oversees timely, accurate, and compliant All-Payer Claims Database (APCD) submissions and reporting to six state agencies.

Reporting to the Director of Risk Adjustment Reporting and Analytics, the Manager works across Member Operations, Provider Information, Claims, IT, Actuarial, vendors, and other stakeholders. The role partners with IT on solution design, data flow analysis, root-cause investigations, implementation planning, and quality assurance. It oversees all EDS/EDPS submissions for Point32Health and serves as the organization's subject matter expert for Medicare Advantage encounter data submissions and APCD reporting.

The Manager leads a team of 3–4 senior analysts and data leads, providing coaching, mentorship, performance management, and professional development. The position is hybrid, with an expectation of one day per week onsite at the Canton, Massachusetts office. The annual base salary range is $122,498.40–$183,747.60. Colleagues are also eligible for variable pay; eligibility and amounts are subject to company discretion.

Requirements

• Bachelor’s degree required.
• 7–10 years in progressively responsible 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 control, 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, such as at a health plan, provider group, or management consultancy.
• Experience managing a team, as well as process improvement and project management experience.
• Highly organized, self-motivated, detail-oriented, and energetic team player.
• Working knowledge of healthcare claims, member, and provider data, data systems, and financial reporting.
• Ability to understand and navigate complex business, operational, and regulatory environments.
• Ability to build partnerships and collaborate effectively with internal and external stakeholders.
• Strong verbal and written communication skills, including one-on-one, small-group, and large-group presentations.
• Excellent judgment, critical thinking, problem-solving, and decision-making abilities.
• Strong process management, process improvement, and project management skills, including managing multiple priorities, driving operational efficiencies, and meeting competing deadlines.
• Expertise in data management, data governance, internal controls, and IT data processes; comfort working with large, complex datasets from disparate sources and using analytical tools to identify patterns, trends, and actionable insights.
• Strong experience with analytical, database, and reporting tools, including SQL (Oracle, SQL Server, Teradata), SAS, Databricks, Alteryx, and Tableau.
• Advanced proficiency in Microsoft Excel, PowerPoint, and Word.
• Experience developing and maintaining detailed documentation of policies, procedures, controls, and analytical processes.
• Ability to work under normal office conditions and from home as required.
• May be required to work additional hours beyond the standard work schedule.

Nice To Haves

• Experience working with CMS, Medicare Advantage risk adjustment, EDS/EDPS and 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 submission and reporting efforts.
• Review the effectiveness, accuracy, and compliance of claims, supplemental data, and APCD submission processes, infrastructure, and reporting; recommend and implement enhancements.
• Oversee data controls, dashboard reporting, routine reconciliations, and regular management updates; present key issues, business updates, and Medicare Advantage risk adjustment performance metrics.
• Collaborate with Actuarial on Medicare Advantage analytics, program and provider-level analyses, and targeting.
• Partner with Claims, Membership Operations, Provider Information, external vendors, IT, and other stakeholders to develop, maintain, and monitor process enhancements and data management mechanisms.
• Lead communication, coordination, issue resolution, and compliance activities with six state agencies for 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 affecting EDS/EDPS and APCD submissions.
• Serve as the organization's subject matter expert for EDS/EDPS and APCD reporting requirements internally and in interactions with CMS and state regulatory 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 justifications with Actuarial, IT, operational, and vendor partners.
• Coordinate required reviews and sign-offs for EDS/EDPS and APCD submissions; oversee acceptance, submission, reconciliation, and tracking of supplemental submissions and deletes.
• Develop internal capabilities and/or partner with vendors on data optimization, maintaining a catalog of data quality, operational efficiency, and submission enhancement opportunities.
• 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, assess operational and reporting impacts, and coordinate timely implementation of required actions, process changes, and compliance obligations.
• Coordinate with vendors and/or Actuarial teams to ensure accurate and complete data is used for valuation, forecasting, targeting, and performance analyses supporting Medicare Advantage products.
• Manage and perform data analytics for ongoing and emerging risk adjustment initiatives; build, maintain, and enhance EDS/EDPS tieback processes and reporting for actuarial valuation exercises.
• Develop executive-level reports, dashboards, and PowerPoint presentations communicating reconciliation results, findings, risks, opportunities, and recommendations.
• Lead and develop a team of 3–4 FTEs, including senior analysts and data leads, through coaching, mentorship, performance management, and professional development.
• Review analytics, reporting, documentation, and technical deliverables for quality, accuracy, and alignment with business objectives; maintain documentation in accordance with departmental standards, policies, and procedures.
• Promote strong collaboration across key stakeholders.

Benefits

• Medical, dental, and vision coverage.
• Retirement plans.
• Paid time off.
• Employer-paid life and disability insurance, with additional buy-up coverage options.
• Tuition program.
• Well-being benefits.
• Benefits supporting career development, individual and family health, and financial health.
• Eligible for variable pay; bonus, commission, benefits, and other compensation eligibility is at the company's discretion.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager