Analyst, Mass Health Performance

The MassHealth Performance Analyst is responsible for leading analytical support including data and business analytics to improve the business performance of the Massachusetts Medicaid products of the Public Plans division. The analyst works closely with medical and pharmacy claims data, as well as member enrollment data, to accurately analyze and report trends through effective planning, analysis, and project support. The primary focus of the role is to design, develop and deploy data driven solutions to facilitate performance improvement opportunities. Responsibilities also include creating analytical solutions to monitor and track successful execution of the performance KPIs. This is a cross functional role that interacts with finance, clinical services, network management, operations, and external clients.

Key Responsibilities/Duties – what you will be doing

• Identify, research, extract, analyze, validate, reconcile, and interpret data for business performance improvement activities through SQL or SAS programming and statistical model building.
• Consult with appropriate Tufts Health Plan staff, managers, and medical directors to refine research questions and analytic approaches.
• Provide complex data and reporting solutions using understanding of business operations and a consultative approach with stakeholders
• Use data visualization techniques to aggregate data and create succinct presentations for relevant stakeholders.
• Automate regular analytic processes to improve accuracy and efficiency.
• Contributes to best practices and standardization for programming activities. This includes implementing a standardized reporting system to generate KPIs.
• Make recommendations for business actions and future analysis.
• Applies knowledge of grouping or stratification tools (e.g., DxCGs, CDPS, DRGs) for health risk-based identification, stratification, or adjustment.
• Creates appropriate documentation for programs, projects and reports.
• Successfully manages multiple tasks to keep projects on track.
• Takes initiative, manages timelines for assigned tasks while being mindful of the team's priorities and timelines.
• Support the overall goals of the MassHealth product team and identifies areas for improvement in data gathering and organization.
• Assists in identifying and recommending protocols for evaluation of state-mandated initiatives and reports.
• Performs other duties as assigned.

Develop internal and external oral and written presentations to reflect performance KPIs and other product specific business insights. This includes but is not limited to:

• Prepare and conduct oral presentations of findings to project work groups and THPP senior management.
• Work cross functionally with other Public Plans teams and partner departments to gather relevant product performance metrics
• Participate in departmental teams and meetings as required.

Qualifications – what you need to perform the job

EDUCATION: (Minimum educations & certifications required)

• Bachelor's Degree in a related field

EXPERIENCE: (Years of experience)

• Minimum of 2-3 years' work experience in an analytic and data management environment, preferably in a health care or managed care setting.

SKILL REQUIREMENTS: (Include interpersonal skills)

• Analytical and creative problem-solving skills.
• Knowledge of SQL or other programming language.
• Understanding of ICD-10, CPT, HCPCS, and other applicable claims billing codes
• Advanced computer skills including Microsoft Office package.
• Ability to plan and execute an analysis while working with stakeholders to ensure project targets are met.
• Ability to work across teams and maintain relationship and mentor junior staff.
• Must be able to work independently, be highly organized and able to manage multiple activities simultaneously. Demonstrate an ability to handle projects simultaneously.
• Must be able to write and speak clearly and effectively to all levels of staff. Must be able to maintain a high degree of professionalism in difficult situations.
• Ability to ensure project quality by maintaining standards, reviewing team member's work, and verifying

CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Will be exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy and department guidelines/policies and all applicable laws and regulations at all times.

*Essential functions occur simultaneously, therefore, the employee must be able to appropriately handle each essential function, prioritize them and seek assistance when necessary. These functions need to be performed on a consistent and regular basis, using good judgment. Ability to learn and apply company policies consistently, seeking out guidance when necessary, is required.

Salary Range

63,756-82,508

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.

This job has been posted by IgnyteAI on behalf of Point32Health. IgnyteAI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of IgnyteAI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law

Req ID: R7380