Fallon Health Medicare Reporting Analyst - Healthcare -advanced excel with ATX or Macros-REMOTE NE States need only apply. in Worcester, Massachusetts
Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.
Brief summary of purpose:
The Medicare Compliance Analyst & Support Specialist position is an essential role within Fallon Health’s Medicare compliance program and includes activities such as the collection and review of data universes for accuracy to protocols, data analysis to identify risks and trends, developing data visualization and dashboards to portray information to Fallon Health Leadership up to the Audit & Compliance Committee of the Board. This position assists with the monitoring of Medicare compliance-related functions as well as audits from the Centers for Medicare & Medicaid Services (CMS). This position is responsible for completing all departmental reporting and project related tasks accurately and within all required timeframes, maintaining a working knowledge of CMS regulations related to audits and reporting, updating policies and processes as needed, and coordinating CMS audits with collaboration from other Medicare Compliance team members. The position requires excellent organizational skills, an understanding of the importance of regulatory and other reporting requirements, the ability to multi-task and change focus quickly, and prioritize work accordingly to ensure the accuracy and integrity of reports. Individuals with strong organizational, technical, data visualization and reporting skills are encouraged to apply.
Primary Job Responsibilities
Perform departmental reporting and analyze data for trending, issue resolution, and opportunities for efficiencies.
Use Excel macros, Alteryx, SQL and Access to develop/update and run queries/reports and ensure integrity of the data.
Understand data sources and the data to complete the reports and analyze the data with management.
Evaluate and collate data with respect to CMS reporting and protocols.
Execute departmental reports at the required frequency with implemented quality check workflows.
Analyze and review data on a regular basis to ensure compliance and consistency.
Communicate data outliers to Medicare Compliance management and as requested to business owners and leadership.
Complete simple ad hoc reporting/queries as needed and in coordination with management staff.
Special projects as assigned.
Identify opportunities to innovate.
Maintain and improve systems and processes to support Fallon Health’s Medicare compliance program and departmental activities, especially concerning the monthly Medicare & PACE Dashboards and Universe submissions.
Understand, use, and translate data, including mastery of all required Program Audit universes.
Analyze department and program information/data to identify trends and risks that are reported back to business areas and vendors for action.
Convert complex subject matter to accessible information.
Support and execute Medicare compliance program activities.
Leverage technology to support assigned program activities.
Maintain documentation of program activities in well-documented processes.
Meet organizational and CMS deadlines.
Perform data analysis and validation to ensure required accuracy and specifications.
Engage with internal business areas and vendors as needed to address issues identified to ensure compliance with audit protocols and reporting.
Coordinate CMS audit deliverables in collaboration from other Medicare Compliance team members to ensure timely and accurate submissions.
Provide support during mock audits and CMS audits with the review of data and coordination of webinars and the supporting materials involved.
Understand and communicate about what we do and why.
Develop working understanding of organizational structure to enhance our Medicare compliance program.
Collaborate with colleagues across departments with a responsive and respectful approach.
Communicate effectively with internal and external partners.
Be self-motivated, take initiative and engage in critical thinking while being task-oriented, with excellent follow through, patience and persistence.
Possess excellent analytical and creative problem-solving abilities, a strong commitment to accuracy and attention to detail.
Aptitude to work in a fast-paced environment, adapt to changing conditions, and meet deadlines.
Proficient with standard office computing applications such as Word, Excel, Outlook or equivalent.
Bachelor’s degree in business, health care or related area or equivalent job experience
2-4 years of experience working in a healthcare or other highly regulated environment; or other relevant specialized experience, training or education
2 years Medicare Advantage experience preferred
PACE requirements knowledge a plus
Competent in SQL, Access, Word, Excel & PowerPoint. Alteryx knowledge a plus. Ability to execute queries. Proficient competences with data analytics, data accuracy, QC & data integrity. Excellent interpersonal, verbal and written communications skills.
Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
Posted Date 5 months ago (9/20/2023 10:40 PM)
Job ID 7427
# Positions 1