Analyst, Mass Health Performance
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 SummaryThe 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
KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS* (in order of importance)
% of TIME
- 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
JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES
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
WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel, overtime)
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.
THIS DESCRIPTION IS NOT INTENDED TO BE A COMPLETE STATEMENT OF JOB CONTENT; RATHER IT ACTS AS A GUIDE TO THE ESSENTIAL FUNCTIONS PERFORMED. MANAGEMENT RETAINS THE DISCRETION TO ADD TO OR CHANGE THE DUTIES OF THE POSITION AT ANY TIME.
Compensation & Total Rewards Overview
The annual base salary range provided for this position represents a broad range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; equity with internal colleagues; and other conditions of employment. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.
Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:
Medical, dental and vision coverage
Paid time off
Employer-paid life and disability insurance with additional buy-up coverage options
Full suite of benefits to support career development, individual & family health, and financial health
For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/
Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity
Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.