Fallon Health

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Healthcare Analyst-Network Development Management-Growing Healthcare Organization !!

Healthcare Analyst-Network Development Management-Growing Healthcare Organization !!

Job ID 
4975
# Positions 
1
Location 
US-MA-Worcester
Posted Date 
10/23/2017
Category 
Network Development

More information about this job

Overview

About Fallon Health:

Founded 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 www.fallonhealth.org.

 

Summary: 

This unique position blends business project management tasks with complex data analysis and reporting skills to support Network Develop and Management’s contracting, strategic and operational goals in a fast paced business environment.

 

Responsibilities

Primary Job Responsibilities:

  1. Ensures FCHP’s provider contracts/health services agreements operate in compliance with government regulations, FCHP’s standards and policies. Research data, regulatory and process improvement opportunities for provider contracting and support.
  2. Manages all aspects of NDM’s reporting, data extracts, and provider data quality resolutions for key provider partners in support of network management business through contract template modifications, report development, analysis, documentation, and distribution. This position will also require providing a level of analytic support for compliance requirements for federally funded programs and submission to state and federal agencies on a monthly, quarterly and annual basis.

  3. Serves as the systems, data and reporting expert resource for NDM.  Elicits, organizes and documents FCHP internal and external customer business requirements to ensure appropriate solutions are developed that support NDM’s and the provider community’s operational and strategic objectives.  Participates in database development and quality teams and is expected to work with the user community, management and technical staff to identify, document, and resolve cross functional data quality issues. 

  4. Liaison to the end-user provider community, all NDM departments and technical developers with respect to data generation, reporting and quality. 

  5. Ensures the development, analysis and distribution of a variety of standard and customized reports and summary output based on specific contractual terms with various physician groups and hospitals that support FCHP’s provider community.

  6. Develops or enhances data gathering and measurement tools for all NDM key operations and prepares dashboard reports for all NDM departments. Trains other NDM analysts or reporting staff to manipulate data variables and run reports at predetermined frequencies.

  7. Quickly learns new business concepts and practices in order to develop a comprehensive understanding of customer issues to be resolved.

  8. Exhibits thorough understanding of project management methodology. Plans and facilitates cross-functional team meetings as required. Participate in analyzing relevant business processes and exchanges of information within and across departments

Duties:

  1. Assist the NDM management team with material review, development, coordination and dissemination of documents required for licensure, accreditation and regulatory agencies. Participate in network development projects including, but not limited to, network strategy and growth and requests for proposals.
  2. Assists NDM with the maintenance of provider and vendor relationships, including contract processing, claims, eligibility and referral issues; contract maintenance and account management issues.
  3. Research proposed changes and regulatory updates for health services agreement templates and user guides; makes recommendations based on analysis. Interfaces with NDM Management, Contract Managers and attorneys, as appropriate.
  4. Extensive data manipulation and report generation using a multitude of systems and programs from various FCHP departments, vendors and regulatory databases.
  5. Actively solicits, analyzes and communicates customer requirements with both business and technical staff in order to ensure the project team develops solutions that meet the business needs.
  6. Meets with users to determine business rules for projects and requests. Gathers and documents business and technical specifications for programming use. Collaborates with developers for extracts and other data requirements, as well as performing or managing testing plans and solution implementation.
  7. Evaluates business processes and identifies business workflow or system modifications that streamline processes to increase efficiency and productivity.
  8. Provide analytic support to the contracting team, Provider Reimbursement, Provider Relations, and other analytical staff to provide ad hoc analyses that may cross product lines or functional areas. Ensures appropriate solutions are developed that support NDM’s and the provider community’s operations and strategic objectives. Performs first level QA for db systems projects.
  9. Provides end-user training and support. 
  10. Other duties as assigned.

Qualifications

Education:  Bachelor’s degree in business, MIS or public healthcare preferred.  Legal office experience a plus.

 

Experience:  

  • 5+ years Business Data Analyst experience in health care, preferably in a managed care setting. 
  • Demonstrated expertise in business project management. 
  • Experience with data warehousing concepts and business applicability in healthcare management including the development of data extracts and output analysis.
  • Advanced MS Office (Excel, Access, Word) and Adobe Professional skills required.
  • Experienced in client/server information systems, SQL and Crystal. QNXT experience helpful.

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