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 fallonhealth.org.

Brief Summary of purpose:

The Senior Health care Data Analyst Analyst will partner with the Manager, Medical Economics as a subject matter expert in data and analysis, demonstrating an in-depth understanding of financial, clinical, and other business data. The position works directly with operational leadership in the design and development of analytical capabilities, reports, and dashboards needed for short and long-term decision-making to achieve success in managing care. This individual provides complex ad hoc analysis and reporting as directed by management to include the evaluation of financial, operational, clinical and general business programs and processes. The Senior Analyst is responsible for data quality and data integrity as they relate to reporting and analytical activities.

Analysis, Decision Support and Business Intelligence – 45%

• Provide actionable analyses and reports that help monitor performance and drive decision making to reduce total medical expense and utilization
• Assist in designing initiatives to impact cost drivers, including measurement and monitoring of initiatives. Identify the cost drivers, quantify variances, formulate and propose strategies and communicate the outcomes to customer, business owners and senior management
• Evaluate the impact of current vs. proposed financial arrangements with providers; compare payment terms against Medicare and Medicaid reimbursement methodologies
• Perform cost and utilization trend analyses at the provider, PHO, employer or other group variation.
• Measure actual performance against benchmarks or targets
• Provide advanced analytical and reporting support to customers on various projects
• Leads or assists in process improvement and special projects

Regulatory & Clinical Model Design and Support – 30%

• Provide support for regulatory reporting; analyze specifications to develop accurate responses or summaries for timely submissions
• Provide analytical support for clinical initiatives including development, evaluation and ROI analyses
• Evaluate the effectiveness of clinical initiatives in improving patient outcomes and reducing health care costs

Ad-Hoc Support – 25%

• Provide support for ad-hoc (i.e. one time) requests that require clinical, financial, regulatory, pharmacy and operational analysis and reporting.
• Prepare reports and supporting analysis for internal and external customers focused on reducing costs and utilization and enhancing healthcare system efficiency.
• Act as a resource for other members of the department on business issues.
• As a subject matter expert, train and guide other associates in the department in data understanding and analytical processes.

Education

Bachelor’s degree in Business, Finance or Public Health

Experience

Strong candidates for this role will have at least three- five years’ experience in health-related complex data analysis, including measurement of cost, quality and health care utilization,

experience working with healthcare claims, clinical and financial data, an understanding of the mechanics of health care cost, and spending and payment

• Minimum of 5 years of financial or analytical experience in healthcare environment
• Experience with data analysis, interpretation and reporting of clinical and financial data
• Experience with Microsoft Excel, ACCESS, SSMS or SQL
• Ability to design, evaluate and interpret complex data sets
• Knowledge of managed care and health care claims
• Excellent oral and written communication skills

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