Sr. Data Analyst, Risk Adjustment

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here.

Job Summary

Under the oversight of the Senior Manager of Consulting and Operations, this individual will support the operations and analysis of risk adjustment strategy across Point32Health business lines. The Data Analyst will assist in managing vendor relationships, monitoring risk adjustment program operations, performing detailed analysis and synthesizing results to develop insights, developing provider group reports, and evaluating vendor and program performance. This person will also provide the risk adjustment department with operational support as needed.

Key Responsibilities/Duties – what you will be doing

Data Analysis

• Support program reporting by developing and maintaining program dashboards, reports and deliverables for internal leadership and external provider organizations
• Extract, transform and analyze health care data from various internal data systems (Oracle, SQL Server, and Teradata) using SAS and SQL knowledge to support risk adjustment initiatives
• Work with internal claims, provider, member data and external analytics vendors to independently perform opportunity analyses across business divisions, product lines and provider groups
• Support the program management team in reviewing data to determine operational impacts and needed actions; elevate issues, trends, areas for improvement and opportunities to management

Data Management

• Establish and manage data transfer methods with vendors, including working with IT to setup and manage secure file transfer sites for vendors that support our risk adjustment programs
• Manage all incoming data from program operations, perform quality checks and disseminate to various stakeholder groups as appropriate
• Maintain organized structure for all incoming data, operational reporting, and program communications. Develop and manage policies and procedures associated with these work efforts

Program Management

• Support the implementation, operations, and evaluation of risk adjustment programs across Point32Health’s Government business, support Commercial business as needed
• Coordinate program operations with various other internal departments, including select member referrals and/or grievances
• Support program close-out and evaluation of vendor and program performance for programs implemented to optimize risk score accuracy for the Government business and Commercial business as necessary

Project Management

• Provide implementation support for risk adjustment vendor implementation and operations related to key data deliverables and requirements
• Take ownership of key tasks associated with program operations such as managing operational and status updates, including but not limited to the collection, organization, and distribution of all incoming risk adjustment program data
• Create, compile and format presentations for a variety of audiences. This includes the supporting worksheets, graphics, supplemental documents

Administration

• Attend meetings, document key decisions, manage follow up actions as necessary
• Serve as department point of contact for various internal and external initiatives, including interdepartmental projects across Point32Health business lines
• Create and manage business policies and procedures and knowledge repositories for the department as needed

Qualifications – what you need to perform the job

EDUCATION, CERTIFICATION AND LICENSURE:

• Bachelor's degree required, preferably in related field such as health informatics, business analysis, IT, finance, decision modeling.

EXPERIENCE (minimum years required):

• Three to five years of experience in analytic