Fallon Health

  • Healthcare Reporting Analyst I - Growing Healthcare Organization

    Location US-MA-Worcester
    Posted Date 2 weeks ago(2 weeks ago)
    Job ID
    # Positions
    Information Technology
  • 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.


    Position Overview:


    This position is responsible for completing all departmental (internal, external and regulatory) reporting and project related tasks accurately and within all required timeframes. The incumbent must have excellent organizational skills, understand the importance of regulatory and other reporting requirements, be professional at all times, be flexible and have the ability to multi-task, and prioritize work accordingly to ensure the accuracy and integrity of operational and enterprise wide reports.


    • Use SQL and Access to run queries/reports and ensure integrity of the data
    • Execute departmental reports at the required frequency with implemented quality check workflows. This reporting includes, but not limited to, production, management, regulatory, performance guarantees etc.
    • Analyze and review data on a regular basis to ensure compliance and consistency.
    • Communicate data outliers to business owners, Analysts and OSS Management.
    • Obtains peer review
    • Complete simple ad hoc reporting/queries for as needed and coordinated with management staff
    • Manage reinsurance process
      • Running queries and analyze data to identify claims that meet the parameters of reinsurance contract to ensure highest level of reimbursement
      • Submitting reports to the finance department and the reinsurance vendor
      • Processing the reimbursements appropriately
      • Ensure the tasks associated with the Model Audit Rule (MAR) are completed timely and accurately.
    • Understand data sources and the data to complete the reports and analyze the data with the Management Team.
    • Special projects as assigned
    • Actively participate analyst meetings
    • Communicate improvement recommendations
    • Participates in continuing education activities to improve upon skills
    • Work collaboratively with Manager and business owners
    • Provides assistance on technical matters and act as a significant information resource
    • Participant in cross functional initiatives






    Competent in SQL, Access, Word, Excel & power point. Ability to execute queries. Proficient competences with data accuracy, QC & data integrity. Excellent interpersonal, verbal and written communications skills.









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