Senior Encounter Data & Reporting Analyst

Fallon Health; Worcester (MA); On-site; USD 125,000 - 130,000; Full time

Job summary

Fallon Health seeks an Information Management Analyst III to lead analysis, validation, reconciliation, and submission of healthcare encounter data to MA regulators. You will collaborate with the Risk Adjustment team to ensure data completeness and accuracy for reimbursement and quality reporting.

You will work cross-functionally with Claims, Enrollment, Provider Operations, IT, Compliance, and Risk Adjustment, mentoring junior analysts and guiding process improvements for data quality and

Qualifications

• 5+ years of healthcare data analytics, encounter reporting, claims reporting, or regulatory reporting experience.
• 5+ years of applied technical skills related to SQL, data analytics, data warehousing techniques, visualization tools, project management, requirements elicitation.
• 5+ years’ experience providing application support or configuration of relevant healthcare / health insurance applications.

Responsibilities

• Monitor encounter submission performance, acknowledgments, rejections, and acceptance rates.
• Analyze and resolve encounter data errors and submission failures.
• Ensure compliance with Massachusetts reporting requirements, submission specifications, and reporting deadlines.
• Coordinate testing and validation activities for system implementations affecting encounter data.
• Partner with the Risk Adjustment team to support diagnosis and encounter data accuracy.
• Assist in identifying gaps in encounter submissions that may impact risk score accuracy.
• Support CMS and internal audit activities related to diagnosis and encounter data validation.
• Act as liaison between business teams, IT departments, vendors, and external agencies.

Skills

SQL

Data analytics

Data warehousing

Visualization tools

Project management

Requirements elicitation

Education

College degree in computer science, engineering, MIS or related

Job description

Fallon Health seeks an Information Management Analyst III to lead analysis, validation, reconciliation, and submission of healthcare encounter data to MA regulators. You will collaborate with the Risk Adjustment team to ensure data completeness and accuracy for reimbursement and quality reporting.

You will work cross-functionally with Claims, Enrollment, Provider Operations, IT, Compliance, and Risk Adjustment, mentoring junior analysts and guiding process improvements for data quality and