Sr. Data Analyst, Risk Adjustment

Who We Are Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier. We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here ( . Job Summary Under the oversight of the Senior Manager of Consulting and Operations, this individual will support the operations and analysis of risk adjustment strategy across Point32Health business lines. The Data Analyst will assist in managing vendor relationships, monitoring risk adjustment program operations, performing detailed analysis and synthesizing results to develop insights, developing provider group reports, and evaluating vendor and program performance. This person will also provide the risk adjustment department with operational support as needed. Key Responsibilities/Duties - what you will be doing Data Analysis Support program reporting by developing and maintaining program dashboards, reports and deliverables for internal leadership and external provider organizations Extract, transform and analyze health care data from various internal data systems (Oracle, SQL Server, and Teradata) using SAS and SQL knowledge to support risk adjustment initiatives Work with internal claims, provider, member data and external analytics vendors to independently perform opportunity analyses across business divisions, product lines and provider groups Support the program management team in reviewing data to determine operational impacts and needed actions; elevate issues, trends, areas for improvement and opportunities to management Data Management Establish and manage data transfer methods with vendors, including working with IT to setup and manage secure file transfer sites for vendors that support our risk adjustment programs Manage all incoming data from program operations, perform quality checks and disseminate to various stakeholder groups as appropriate Maintain organized structure for all incoming data, operational reporting, and program communications. Develop and manage policies and procedures associated with these work efforts Program Management Support the implementation, operations, and evaluation of risk adjustment programs across Point32Health's Government business, support Commercial business as needed Coordinate program operations with various other internal departments, including select member referrals and/or grievances Support program close-out and evaluation of vendor and program performance for programs implemented to optimize risk score accuracy for the Government business and Commercial business as necessary Project Management Provide implementation support for risk adjustment vendor implementation and operations related to key data deliverables and requirements Take ownership of key tasks associated with program operations such as managing operational and status updates, including but not limited to the collection, organization, and distribution of all incoming risk adjustment program data Create, compile and format presentations for a variety of audiences. This includes the supporting worksheets, graphics, supplemental documents Administration Attend meetings, document key decisions, manage follow up actions as necessary Serve as department point of contact for various internal and external initiatives, including interdepartmental projects across Point32Health business lines Create and manage business policies and procedures and knowledge repositories for the department as needed Qualifications - what you need to perform the job EDUCATION, CERTIFICATION AND LICENSURE: Bachelor's degree required, preferably in related field such as health informatics, business analysis, IT, finance, decision modeling. EXPERIENCE (minimum years required) : Three to five years of experience in analytical roles in the health care or health insurance sector either for a health plan, provider group, healthcare IT / management consultancy or auditing firm. Understanding of claims systems, provider information, Medicaid/Medicare, and/or experience working with large data sets preferred. SKILL REQUIREMENTS: Engaged, critical thinker, organized, detail-oriented, resourceful, and self-motivated Comfortable working with large data sets from disparate sources, and able to identify relevant patterns and trends Expertise in SAS Enterprise Guide/ SAS Base and SQL/ProcSQL (SAS certification preferred) Experience with database software and reporting tools such as SQL Server, Oracle, and Cognos Experience with Alteryx, Cloudera and Tableau is a plus Proficient in Microsoft Excel, PowerPoint, and Word Strong interpersonal and communication skills Ability to work collaboratively with both internal and external resources Ability to take responsibility, prioritize tasks and follow through to completion Compensation & Total Rewards Overview As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law. Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes: 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 Full suite of benefits to support career development, individual & family health, and financial health For more details on our total rewards programs, visit Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity "‹Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do"”from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. Scam Alert : Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact At Point32Health, we strive to be a different kind of nonprofit health and well-being company, with a broad range of health plans, and innovative tools that make navigating health and well-being easier, guiding our members at every step of their health care journey to better health outcomes. We are committed to providing high-quality and affordable health care, improving the health and wellness of our members, and creating healthier communities across the country. The Point32Health name is inspired by the 32 points on a compass. It speaks to the critical role we play in guiding and empowering the people we serve to achieve healthier lives. Our employees are hard-working, innovative, and collaborative. They look for opportunities to grow and make a difference, and they help make us strive to be one of the Top Places to work in New England.

Created: 2024-11-18