83 applicants
WellSense Health Plan · 2 days ago
Regulatory Operations Reporting Analyst
Boston, MA
Contract
Remote
Mid, Senior Level
5+ years exp
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Insider Connection @WellSense Health Plan
Responsibilities
Creates and submits monthly, quarterly and annual regulatory reporting, working with business areas to validate accuracy of data
Creates and submits ad hoc regulatory reports as required
Develops business requirements and works with IT to obtain data and create reports
Maintains the accuracy and integrity of data universe tables
Performs quality review of data to ensure reports contain required data
Regular internal audits of data to ensure accuracy and preparedness
Works with vendors to ensure reporting timeliness and accuracy; works with Sourcing and Supplier Management to recover liquidated damages
Works with business leaders to validate attestations
Oversees the development and maintenance of internal controls and quality assurance to monitor against all applicable standards
Participates in appropriate committees that support program compliance
Acts as liaison to Compliance, Legal and Public Partnerships Departments
Creates centralized repositories for regulatory reporting and RFP materials
Reporting includes but is not limited to:
SCO reporting – monthly, quarterly, annual managed by Public Partnerships
ACO/MCO reporting – monthly, quarterly, annual managed by Public Partnerships
NH Medicaid reporting – monthly, quarterly, annual managed by NH Medicaid Operations
Annual CMS Part C reporting – ODAG
Audit data universe tables
Coordination of supplier reporting
State and federal ad hoc reporting as requested
Qualification
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Required
Bachelor’s Degree in Data Science, Mathematics, Statistics or an equivalent combination of education, training and experience is required
5+ years of experience in data analysis or related roles
Proficiency in statistical software (e.g., Python, R) and data manipulation tools (e.g., Excel(VBA), SQL, PowerQuery)
Experience with data visualization tools (e.g., Tableau, Power BI)
Successful completion of pre-employment background check
Employees must provide high-speed internet meeting minimum required standards
Employees are required to have a quiet and distraction-free working space and protect confidential information
Strong skills in data analysis and statistical modeling
Strong Excel skills
Familiarity with SQL, VBA, Python or other programming languages
Understanding of data warehousing and ETL techniques
Strong problem-solving skills and ability to work independently
Excellent organization and proven process improvement skills
Ability to discern regulatory details and requirements from contracts
Demonstrated ability to successfully plan, organize and manage projects
Detail-oriented, excellent proofreading and editing skills
Demonstrated ability in facilitating cross-functional teams and encouraging positive collaboration and communication
Demonstrated ability to work independently and manage multiple projects simultaneously
Demonstrated commitment to excellent customer service for both internal and external customers
Understands and is able to work in highly matrixed environments
Effective collaborative and proven process improvement skills
Strong oral and written communication skills; ability to interact within all levels of the organization as well as with external contacts
Ability to work in a fast-paced environment
Regular and reliable attendance is an essential function of the position
Work is normally performed in a remote office work environment; limited travel may be required
Ability to work East Coast business hours
No or very limited physical effort required
No or very limited exposure to physical risk
Preferred
Master’s degree in Data Science, Mathematics, Statistics or a related field preferred
3-5 years’ experience with Medicare or Medicaid regulatory reporting
Advanced proficiency in statistical software (e.g., Python, R) and data manipulation tools (e.g., SQL)
Expertise in data visualization tools (e.g., Tableau, Power BI) and complex dashboard creation
Benefits
Full-time remote work
Competitive salaries
Excellent benefits
Company
WellSense Health Plan
A nonprofit health plan serving Medicare, Individual & Family, and Medicaid plan members in Massachusetts & New Hampshire.
1,001-5,000 employees
Funding
Current Stage
Late StageLeadership Team
Heather Thiltgen
President & CEO
Diana Cruz
Chief Operating Officer
Company data provided by crunchbase
