Fallon Health Senior Quality Data Analyst-Growing Healthcare Organization in Worcester, Massachusetts

More information about this job


About Fallon Health:

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.

Position Summary:

Under the general direction of the Prinicpal Analyst and Manager of Data Analysis, is responsible for data collection, analysis and reporting of quality projects for the Quality Programs Department. Responsible for the calculation, documentation and reporting of assigned measures within the CMS 5 STAR measurement system and Healthcare Effectiveness Data and Information Set (HEDIS). Additional data managment responsibilites include the design and maintenance of software programs used to manage data sources for departmental quality initiatives. In addition to these specific areas, this position is responsible for providing technical, database and statistical expertise to support projects for the Quality Programs Department.


Primary job responsibilities:

  • Participates in the development of annual HEDIS project plan to ensure all components and timelines are defined, monitored and met.

  • Designs, programs and maintains software programs in MS Access to manage data sources for assigned HEDIS hybrid measures.

  • Provides supporting documentation for compliance audit to verify processes and procedures as requested by the external audit firm.

  • Develops source code to calculate CMS 5 STAR and HEDIS measures from the plan's data warehouse.

  • Adheres to the technical specifications as outlined by NCQA. Assist with education of other department members on understanding the technical specifications.

  • Responsible for providing documentation for assigned sections of NCQA’s HEDISRoadmapto certified HEDIS auditors.

  • Develops report of HEDIS results for various customers both internally and externally, including statitcal analysis and trending of national, regional and competitive results using valid statistical methodolgies.

  • Develops data management tools to support quality improvement clinical projects such as CMS 5 STAR measurements.

  • Analyzes reported HEDIS and CMS 5 STAR measure results for the purpose of identifying trends, oppurtunities for improvement and/or specification enhancements.


Education, Licenses, certification and experience requirements:

Education: : Master’s Degree in business, healthcare or other related field preferred


License: N/A      

Certification: N/A      

Experience: Minimum 8-10 years experience in a Healthcare environment with responsibilities for report production, data analysis and manipulation and database management as well as working knowledge with statistical analysis, trending techniques, and investigative research.

Proficiency in the following software applications required:

  • 3-5 years experience with SAS or similar software

  • Working knowledge of the following software applications required:

  • Microsoft Access

  • Microsoft Word

  • Microsoft Excel

Job ID 4615

# Positions 1

Location US - MA - Worcester

Posted Date 11/29/2016

Category Quality