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Analyst II Network Development Management - Great Healthcare Organization - Hybrid Schedule..

Company: Fallon Community Health Plan
Location: Worcester
Posted on: January 15, 2022

Job Description:

Analyst II Network Development Management - Great Healthcare Organization - Hybrid Schedule..US-MA-WorcesterJob ID: 6628Type: Full Time# of Openings: 1Category: Network DevelopmentFallon Health - Corp HQOverviewAbout Fallon HealthFounded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation's top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org. Fallon Health Vaccination Requirements:To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022 all roles not designated as "Remote" require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment. Brief summary of purpose:Consults, designs and produces provider data information/reporting to assist in business and network development to support key initiatives for senior leadership, provider network development and provider relations. Responsible for both production and adhoc reporting including required reports for governmental agencies such as CMS, DOI and MassHealth. Responsible for analyzing member accessibility of current and prospective provider networks; including vendor requests and requests-for-proposal (RFP). Assists in the analysis, development and implementation of new product solutions in support of organizational growth. ResponsibilitiesPrimary Job ResponsibilitiesPrepares comprehensive data analysis using information from FCHP systems (including but not limited to, the Enterprise Data warehouse, Avenue, QNXT replicated service) in an accurate and timely fashion for internal and external customers. Uses querying and programming skills to develop production and ad hoc reports using both small and very large data sets. Reviews all reports and outputs for internal consistency and reasonableness.Establishes and maintains positive, collaborative relationships with other Fallon departments such as IT, Quality, Sales, Finance, Government Programs, OSS and Product Development. Consults with customers so as to actively engage them in defining their requests. Works collaboratively with peers to assist with areas of expertise. Completes ad hoc reporting as requested by internal customers, as needed. Provides assistance on technical matters and acts as a significant information resource.Responsible for developing/ maintaining reports for State and Federal agencies including DOI, MassHealth and Medicare Programs. Multiple reports produced and submitted on a monthly, quarterly and annual basis to satisfy regulatory requirements. Reviews the annual updates/specifications from State Agencies and modifies reports as necessary. This includes maintenance of databases for government agencies including required documentation. Completes the reporting package and facilitates the State attestation concerning Fallon providers and the network.Responsible for creating monthly reports for providers including accuracy review, addressing variance in reporting by provider and posting to EDI gateway. Primary point of contact for eVIPS, contract management system. Responsible for completing the platform testing (when system is upgraded). Builds databases for provider tracking and reporting packages as requested by internal customers.Develops clear documentation and training for NDM department to modify and run developed, canned reports.Constantly works to identify opportunities for improvement in work process and reports.Utilizes Quest Analytics software to produce detailed maps, network adequacy reports, Health Service Delivery (HSD) tables for CMS and member/employee's accessibility to Fallon Health's providers (PCP's, Specialists, Hospitals, etc).QualificationsBS / BA with coursework in computing programming / business / MIS or public healthcare preferred or related work experience SQL Query - Certificate of Completion requiredAdvanced MS Excel - Certificate of Completion required 5+ years Business Data Analyst experience in health care, preferably in a managed care settingDemonstrated expertise in business project managementProficient in Data Analysis, SQL, Quest, Alteryx, Ipswitch, Business Objects and MS office including Access, Word and Excel. Skilled in the ability to create, modify and execute moderate to advance queries. Keen aptitude in analyzing, interpreting and communicating outputs, including those of large data sets. Capable of designing reporting outputs (with automation features) for all levels of the organization. Minimum of 3 years' experience in data integrity analysis.Demonstrated experience in managing large projects from development to completion (including detailed documentation, acting as liaison with key areas and keen sense of innovation to accomplish initiatives).Experience in using and analyzing large healthcare data sets and relational databases. Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. PM16PI160578450

Keywords: Fallon Community Health Plan, Worcester , Analyst II Network Development Management - Great Healthcare Organization - Hybrid Schedule.., Executive , Worcester, Massachusetts

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