Senior Encounter Data & Reporting Analyst

Fallon Community Health Plan, Inc.; Worcester, Northern (MA, KY); Hybrid; USD 125,000 - 130,000; Full time

Job summary

Fallon Health in Worcester, MA is seeking an Information Management Analyst III to lead analysis, validation, reconciliation, and submission of healthcare encounter data to the Commonwealth of Massachusetts and other regulators. You will collaborate across Claims, Enrollment, IT, Compliance, and Risk Adjustment to ensure data accuracy and timely reporting.

The role requires 5+ years in healthcare data analytics and strong SQL/data warehousing skills, with mentorship responsibilities and

Qualifications

• 5+ years of healthcare data analytics, encounter reporting, claims reporting, or regulatory reporting experience.
• 5+ years 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.
• Translate business and regulatory requirements into reporting and technical specifications.
• Lead issue resolution meetings involving encounter reporting and data quality concerns.
• Participate in enterprise initiatives impacting healthcare data management and reporting processes.
• Build leadership skills through project leadership and stakeholder management responsibilities.
• Mentor junior analysts and new team members.
• Review work products and provide quality assurance guidance.
• Assist with prioritization of team workload and reporting schedules.
• Lead special projects and continuous improvement initiatives.
• Provide subject matter expertise during audits, implementations, and strategic initiatives
• Analysis and support of the Interoperability data streams.

Skills

Healthcare data analytics

SQL

Data warehousing

Data visualization tools

Project management

Education

College degree in computer science, engineering, MIS or related

Tools

SQL tools

Data visualization tools

Job description

Fallon Health in Worcester, MA is seeking an Information Management Analyst III to lead analysis, validation, reconciliation, and submission of healthcare encounter data to the Commonwealth of Massachusetts and other regulators. You will collaborate across Claims, Enrollment, IT, Compliance, and Risk Adjustment to ensure data accuracy and timely reporting.

The role requires 5+ years in healthcare data analytics and strong SQL/data warehousing skills, with mentorship responsibilities and