Blue Cross Blue Shield of Massachusetts Healthcare Data Analyst in Hingham, Massachusetts

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Provide analytical support to the Risk Adjustment Team on Data Submissions (EDPS/RAPS/EDGE). This position requires a high-energy, detail-oriented and enthusiastic individual interested in improving health plan quality and performance. The successful candidate will support in-depth data analysis and interpretation of CMS reporting and guidance, development of ad- hoc reports, work on special projects, program documentation, monitoring of plan deliverable due dates and will collaborate with Business Leads on project planning in pursuit of a 99%+ acceptance rate on EDPS. The analyst also updates policies and procedures, and provides input on strategies for maintaining and implementing additional activities as they arise. This individual must communicate with confidence, build relationships through inspiring trust and sharing information and be able to challenge assumptions. The role requires frequent interaction with directors and managers in Medicare Market Operations, Commercial Operations, IT and others.

Position Summary:Provide analytical support to the Risk Adjustment Team on Data Submissions (EDPS/RAPS/EDGE). This position requires a high-energy, detail-oriented and enthusiastic individual interested in improving health plan quality and performance. The successful candidate will support in-depth data analysis and interpretation of CMS reporting and guidance, development of ad- hoc reports, work on special projects, program documentation, monitoring of plan deliverable due dates and will collaborate with Business Leads on project planning in pursuit of a 99%+ acceptance rate on EDPS. The analyst also updates policies and procedures, and provides input on strategies for maintaining and implementing additional activities as they arise. This individual must communicate with confidence, build relationships through inspiring trust and sharing information and be able to challenge assumptions. The role requires frequent interaction with directors and managers in Medicare Market Operations, Commercial Operations, IT and others. Key Accountabilities:

  • Subject matter expert in risk adjustment submissions (EDGE, Encounters and RAPs) and Commercial H-RADV, Medicare RADV

  • Review and synthesize CMS and Vendor reports to develop metrics, make recommendations for improvement, quantify differences

  • Work closely with the Claims, IT, Actuarial teams to trouble shoot rejects, develop solutions, and implement changes.

  • Prepare data and analyses/reports as needed to support activities

  • Identify opportunities to improve processes and submissions to support the Medicare Advantage Plan and Commercial Plans and ensure our ability to meet compliance and revenue goals. This includes, but is not limited to participating in workgroups and initiatives to develop and make recommendations to Leadership

  • Support requests for adhoc analysis leveraging disparate data sources including response files and the Data Warehouse.

  • Develop and utilize an understanding of the business to evaluate and analyze internal processes and will make recommendations and propose solutions for process improvement

  • Manages multiple projects by effectively prioritizing work

  • Contributes to team environment by accomplishing related tasks as needed

  • Clearly and concisely present analytic information to internal and external audiences, both orally and in written format

  • Works closely with Senior Analyst to resolve complex problems and issues independently and escalating as appropriate.

  • Work requires analytical interpretation, independent problem solving and resolution

  • Critically review results of analytics to make recommendations on process improvements, vendor remediation, changes to strategic approaches, etc

  • Monitor related guidance and keep relevant stakeholders informed

  • Interact with all departments, maintain effective team relationships and share best practices with leaders and associates

  • Demonstrate loyalty, integrity and professionalism

  • Foster a team-based environment by participating in projects and activities that support the goals of the team

Qualifications (knowledge/skills/abilities/behaviors):

  • Experience with Data Warehouse, Access, and Excel

  • Strong oral and written communication skills

  • High degree of professionalism; ability to adapt communication style, methods of delivery, and the content of message to meet the needs of audience

  • Excellent time management and organizational skills; strong attention to detail

  • Strong analytic experience using large data sets

Experience and Qualifications:

  • Bachelor's degree preferred or equivalent work experience

  • Minimum of 2-4 years in Medicare plan, health insurance or quality improvement program

  • Demonstrated experience of reporting access databases and Data Warehouse

  • Strong analytical skills in interpretation and reporting of data.

  • Strong understanding of Medicare Advantage environment and IT infrastructure High proficiency in problem solving and analytical skills

  • The Business Analyst should be prepared to build on a strong knowledge base of health plan operations. The successful candidate will be highly self-motivated.

  • Requires demonstrated analytical and decision making skills

  • Ability to document and present findings to a variety of audiences at all levels of the organization

  • High proficiency in maintaining and querying large datasets

  • Excellent judgment and the ability/willingness to think critically

  • Demonstrated ability to handle multiple tasks simultaneously

  • The ability to work independently on multiple projects and in a collaborative team environment

  • Aptitude to effectively plan and facilitate meetings and workgroups.

  • High degree of initiative and professionalism; ability to effectively interact with all levels of an organization.

  • Willingness to develop new technical skills

Education/Relevant Experience:

  • Bachelor's degree or equivalent work experience required.

  • 2+ years analytic experience in a support role preferred

  • 4-6 years of business experience in health insurance operations. Industry knowledge of Risk Adjustment is strongly preferred.

#LI- DNI

LocationHinghamTime TypeFull time

Voted as the highest in member satisfaction among Massachusetts commercial health plans by JD Power, Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 75 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 2.8 million members, and consistently offering security, stability, and peace of mind to both our members and associates.

Our Commitment to You

We are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating a refreshing and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance.

Blue Cross Blue Shield of Massachusetts is an Equal Employment / Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law.

Blue Cross Blue Shield of Massachusetts will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Blue Cross Blue Shield of Massachusetts's legal duty to furnish information.