Information Management Analyst lll - Growing Healthcare Org!

Fallon Health is a mission-driven, not-for-profit organization founded in 1977 in Worcester, Massachusetts. We deliver equitable, high-quality, coordinated care and are continually rated among the nation’s top health plans for member experience, service, and clinical quality. Our individual differences—life experiences, knowledge, self-expression, and unique capabilities—enable us to better serve our members. Today, 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.

This position requires permanent work authorization in the U.S. and is open to candidates residing in MA, CT, RI, NH, NY (excluding NYC boroughs), FL, GA, TX, NJ, ME, or VT.

About the role

The Information Management Analyst III, Encounter Reporting & Risk Adjustment Support leads the analysis, validation, reconciliation, and submission of healthcare encounter data to the Commonwealth of Massachusetts and other regulatory entities. This role serves as a subject matter expert in encounter reporting and collaborates closely with the Risk Adjustment Department to ensure data completeness, accuracy, and integrity for reimbursement, regulatory compliance, and quality reporting. The position works cross-functionally with Claims, Enrollment, Provider Operations, Information Technology, Compliance, and Risk Adjustment teams to identify data quality issues, investigate discrepancies, and implement process improvements. The individual will also provide mentorship, project leadership, and operational guidance to support succession planning for a future leadership role within the Encounter Reporting function.

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.

Requirements

• College degree in computer science, engineering, management information systems, or related discipline. Other degrees will be considered with appropriate background and experience.
• 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, and requirements elicitation.
• 5+ years of experience providing application support or configuration of relevant healthcare or health insurance applications.

Pay

$125,000 - $130,000 annually. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.