OSS Manager, Reporting & Analytics

About us:

Fallon Health is a company that cares. We prioritize our members-always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, 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. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief summary of purpose:

Leads the analyst team in the delivery of best in class, data driven decision support for analytics and process improvement. Key deliverables include the Multi-disciplinary Executive dashboard presented to Sr Leadership in addition to strategic management and oversight of analytics driving key strategic responses including Operational performance, Integrity reporting and root cause analysis for significant and material operational and financial drivers. Responsible for the presentation and when appropriate escalation of deliverables to key internal and external constituents as required including Sr Leadership. Scope extends across Operations including Customer service, Claims, Configuration, Clinical Operations, EDI, 5 Star and Enrollment and Billing but further requires keen understanding of organizational contracting and clinical practices to support holistic recommendations supporting organizational efficiency, compliance and improvement approaches.

Needs to be an organized self-starter who proactively works to identify and resolve issues, is comfortable dealing with internal and external leaders and is able to build and maintain influential relationships required to implement key initiatives. Must be innovative, diplomatic, and detail oriented.

The Manager of Reporting and Analytics is responsible for the development of a high performing team.

Primary Job Responsibilities

Overall

Function as a key, contributing member of the Operations leadership team
• Support the Operations strategic planning process as well as assess and cultivate goals for operational analytics in conjunction with organizational and department leaders, regulators, and other key stakeholders.
• Think strategically and operate tactically to drive and deliver business value
• Work with operational leadership and other areas as applicable to understand priorities and expectations in support of operational trends/reporting
• Collaborate with business leads to prioritize demand to enable optimal delivery of solutions
• Maintain good communication around issues and opportunities
• Provides customer satisfaction to both internal and external customer and strives to continuously improve service delivery and quality.
• Serve as point of escalation with internal and external customers/business partners as necessary to resolve issues.
• Works closely with OSS leadership to Identify and implements initiatives that result in overall service improvement for Fallon Health and its members.
• Keep abreast of relevant regulatory (pending and potential) updates. Identify and plan for potential impact to Operation Support Services
• Promote the use of accepted best practices and innovative strategies for reporting, analytics and training
• Analyzes and evaluates staff recommendations and present opportunities to OSS leadership to implement changes, utilizing knowledge of reports analysis and standardization, managerial processes and systems, budgetary limitations, and organizational policies and procedures.

Analytics

• Continuously monitor all metrics and trends and drive deep, creative, and rigorous analysis to thoroughly assess performance. He/she must understand and explore a comprehensive suite of metrics that provide insight into all facets of the line of business and serve as leading indicators of the operational health of the business. Includes the optimization of scalable solutions.
• Identify and answer key strategic questions that will shape and define how Fallon Health measures and runs the business. He/she must proactively and continuously define these questions and shape analysis around them potentially with incomplete information and garner buy-in from key stakeholders.
• Maintain and improve upon the strategy to track and manage, reports on the portfolio of projects and key metrics associated with the program.
• Directs and coordinates activities of Analysts involved with development and analysis of business reports:
• Provide key metrics/reporting to leadership for departments under the COO
• Share trends from data collection to areas to identify opportunities for improvements
• Provides accurate and timely information to the Fallon Health and maintain regulatory compliance. Integrity, planning, flexibility and priority planning are critical.
• Plans and directs staff activities intended to develop new or revised reports format, utilizing knowledge of principles and techniques of information and documents management, HIPAA protection, and cost-control practices.

Resource and Staff Development and Management

• Selects, promotes, develops & retains talent to meet business objectives. Conducts regularly scheduled departmental assessments to ensure range/title equity and appropriate spans of control, includes the development of a career path for staff.
• Ensure team has appropriate resources and highlights areas of need to upper Management for resolution.
• Recruit, motivate and retain staff. Ensure appropriate training programs are in place to attract, retain and develop key personnel.
• Manage and develop staff
  • Ensure objectives defined across a broader group are integrated and supportive where necessary.
  • Hire for, develop and recognize the experience and knowledge/skills/abilities required for a successful team.
  • Work with OSS Leadership to help define performance expectations and goals for staff.
• Provide coaching and mentoring to direct reports and staff.
• Provide guidance and leadership to direct reports to ensure effective team environments through efficient leadership, motivational and organizational methods.
• Ensure adherence to established HR practices and protocols, champion teamwork and mutual respect and maintain the highest level of professionalism.
• Monitor work of individual staff for efficiency, effectiveness and quality. Provide ongoing constructive feedback and guidance to staff.
• Evaluate staff on achievement of goals and deliverables and assessment of competencies. Help staff progress in their careers to the benefit of the department and broader organization. Manage the resolution of performance issues in consultation with Human Resources as appropriate.
• Establish and maintain effective channels of communication

Independent Activity

• Uses querying and programming skills to run and modify production and ad hoc reports using both small and large data sets
• Uses skills to analyze data for trends and consults business area in applying outputs
• Works to improve data quality and collection process to meet diverse and changing needs for service improvement activities
• Works with business owners to research root cause and communicate improvement recommendations
• Collects statistical information to determine whether business areas have negative impacts on their businesses, or at least improve their business practice

Bachelor's Degree, Business Administration or Computer Science preferred; MBA preferred or 4+ years operations management experience

Experience:

• Demonstrated effectiveness bridging technology & business perspectives to collaboratively achieve shared project objectives
• Demonstrable skill and talent, interpreting, understanding and communicating data to leadership into usable information required
• Demonstrated skill in leading cross-functional teams
• Ability to facilitate meetings with senior leaders throughout the organization.
• Ability to coach, guide and lead team of direct reports which includes developing and monitoring staff performance to maximize staff level performance.
• Excellent interpersonal, verbal and written communications skills. Ability to facilitate requirement sessions.
• Proficient in Data Analysis, T- SQL, Visual Basics, MS Visio and MS office including Access, Word, Excel & Power point. Skilled in the ability to create, modify and execute moderate to advance queries.
• Keen aptitude in analyzing, interpreting, and communicating outputs, including those of large data sets. Capable of designing reporting outputs (with automation features) for all levels of the organization.
• Extensive knowledge of Medicare, Medicaid and Commercial regulations, legislation and laws with leadership skills in developing auditing protocols, reports and system functions to support these regulations and industry requirements.
• Experience developing, implementing and monitoring training curriculums to maximize staff level performance. Demonstrated experience developing cost benefit analysis and building business cases.
• Comprehensive skill in managing multiple, conflicting priorities and excellent relationship skills required.
• Proven ability to understand concepts and coordinate tools to facilitate accurate, timely and efficient reporting required.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.