MassHealth is seeking qualified applicants for the position of Data Quality Manager – 837 Specialistwithin the Data & Analytics department. Reporting to the Senior Manager – Data Quality Platform within the Data Integrity team, the Data Quality Manager will lead workstreams and projects to analyze, monitor, and improve Encounter Data quality. Additionally, the incumbent will perform readiness activities to support MassHealth’s implementation of a standardized ASC X12 837ANSIand NCPDP PACDR format for Encounter Data reporting. Background: MassHealth is Massachusetts’ Medicaid and Children’s Health Insurance Program. MassHealth provides comprehensive health care coverage to more than 2 million residents of the Commonwealth, including 40% of all Massachusetts children and 60% of all residents with disabilities. MassHealth’s mission is to improve the health outcomes of our diverse members and their families by providing access to integrated health care services that sustainably and equitably promote health, well-being, independence, and quality of life. MassHealth operates as part of the Massachusetts Executive Office of Health and Human Services (EOHHS) and partners closely with other EOHHS agencies. The Data Integrity Team was formed in 2019 under the Data & Analytics department to coordinate data quality and data management processes across MassHealth.Our mission is to maximize the business value delivered by MassHealth data assets by promoting data management best practices. Alongside our business and technical partners, we assess data quality to confirm data is complete, accurate, consistent, reliable, and timely to allow other teams to complete their essential job functions and workflows. We manage data governance to codify policies and ensure updates to data assets meet current business needs and can adapt to future ones. Encounter Data is a critical data asset for MassHealth. Encounter Data are the records of services delivered to Medicaid beneficiaries enrolled in managed care plans that receive a capitated, per-member-per-month payment. Encounter Data is used for program oversight, administration, forecasting, and integrity. In collaboration with MassHealth business and technical teams, the Data Integrity Team monitors, assesses, and remediates data quality issues. Our team recommends and implements policy, process, and technology improvements. Our team also partners with Managed Care Entities to delivery data quality feedback to them and to establish remediation plans. The preferred candidate has experience analyzing Encounter Data, has worked with claims in 837 ANSI format and/or NCPDP format, and is familiar with CMS T-MSIS reporting requirements. _Duties and Responsibilities (these duties are a general summary and not all inclusive)_: Analyze, monitor, and enhance current state Encounter Data submission and processing. * Serve as Data Quality Steward for current state Encounter Data requirements. * Create and review data quality alerts, reports, and dashboards to confirm whether data issues are present. * Develop and manage statistics on Data Quality status over time; track volume of confirmed issues and incidence of re-breaks by health plan. * Coordinate with Business stakeholders, MCEs (Managed Care Entity), and EDME (Enterprise Data Management and Engineering) teams to investigate, confirm, and remediate data issues. * Coordinate with T-MSIS Reporting Team to ensure data quality issues identified by CMS are prioritized and remediated. Lead workstreams and readiness activities tosupport MassHealth’s implementation of a standardized ASC X12 837 and NCPDP PACDR format for Encounter Data reporting. * Develop deep understanding of future state Encounter Data requirements, including data flows and processing from MCEs through EDI vendor to MassHealth DW. * Identify and coordinate activities to resolve gaps in Encounter Data requirements between current state and future state systems. * Identify opportunities for improved Encounter Data quality through new and enhanced transaction validation rules. * Support testing, UAT, and go-live preparation as part of readiness activities. Serve as SME (subject matter expert) and Data Translator for MassHealth Encounter Data; promote data management best practices with business users. * Engage with business users, analytics, EDME, vendors, and external parties to review, clarify, and enforce policies and standards for Encounter Data. * Advise business users on data quality best practices; coach users on defining clear, unambiguous, specific requirements when submitting potential data issues and/or requesting enhancements. _Required Qualifications_: * Ability to set goals and strive for excellence or improvement. * Ability to identify a problem or opportunity and take action to address current or future problems and opportunities. * Ability to think through problems, organize information, and identify key factors and underlying causes to generate solutions. * Ability to work cooperatively with others and be part of a team. _Preferred Qualifications_: * __2-4 years of experience in analytics, operations, product management, or consulting, or other relevant work experience. * Experience analyzing, processing, and validating Encounter Data for Medicaid and/or Medicare beneficiaries. * Experience with Data Quality, including writing validation rules and investigating issues. * Demonstrated problem solving and analytical skills. * Collaboration with cross-functional teams across Business, Analytics, and Information Technology. * Proven ability to communicate effectively with both business and technical stakeholders. * Proven ability to lead effective meetings and work sessions, with all levels of staff and leadership. * Experience creating and synthesizing business process workflows and data flows. * Experience analyzing and manipulating healthcare data such as enrollment, provider, and claims data is strongly preferred. * Knowledge of T-MSIS Encounter Data Reporting Requirements to CMS. * Experience with Project Management, including workplan development and issue & risk mitigation. * Experience in relational databases, SQL, data visualization, and business intelligence tools such as Tableau. * Experience working with JIRA or other issue and project tracking applications. * Strong customer service orientation with the ability to understand customer needs. * Strong relationship building capabilities with a focus on partnership. * Have a high willingness to learn new subject matter, skills and technologies. * Comfortable with ambiguity and conflicting information. * Ability to clearly articulate project or program needs to accomplish goals. * Excellent time management skills, ability to multi-task, and work under time constraints. * Knowledge of Microsoft Office 365 applications. _TO APPLY_: Please upload both Resume and Cover Letter for this position when applying. First consideration will be given to those applicants that apply within the first 14 days. _About MassHealth_ To improve the health outcomes of our diverse members and their families by providing access to integrated health care services that promote sustainable & equitable health, well-being, independence and quality of life. For more information about our agency and programs please visit:www.mass.gov/masshealth _Pre-Offer Process_: A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visithttp://www.mass.gov/hhs/cori Education, licensure and certifications will be verified in accordance with the Human Resources Division’s Hiring Guidelines. Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth’s website. If you require assistance with the application/interview process and would like to request an ADA accommodation, please click on the link and complete ADA Reasonable Accommodation Request Form For questions, please the contact the Executive Office of Health and Human Services Human Resources at 1-800-510-4122 and select option #4. MINIMUM ENTRANCE REQUIREMENTS: Applicants must have at least (A) four (4) years of full-time or, equivalent part-time, professional, professional internship, administrative, supervisory, or managerial experience in business administration, business management, public administration, public management, clinical administration or clinical management or (B) any equivalent combination of the required experience and substitutions below. Substitutions: I. A certificate in a relevant or related field may be substituted for one (1) year of the required experience. II. An Associate's degree in a related field may be substituted for one (1) year of the required experience. III. A Bachelor's degree in a related field may be substituted for two (2) years of the required experience. IV. A Graduate degree in a related field may be substituted for three (3) years of the required experience. V. A Doctorate degree in a related field may be substituted for the required experience. *Comprehensive Benefits* When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future. Want the specifics? Explore our Employee Benefits and Rewards! An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply. The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role. *Job: Administrative Services *Organization: Exec Office Of Health and Human Services *Title: *Data Quality Manager – 837 Specialist Location: Massachusetts-Boston-1 Ashburton Place Requisition ID: 240000FQ