Champion Health Plan is seeking a Data Integration \& Reporting Analyst to support our Medicare Advantage Prescription Drug (MAPD) operations. This on\-site position is based in our Long Beach, CA office.
The ideal candidate will have a strong technical background and a proactive mindset, with experience managing SFTP/EDI data exchanges, building CMS\-compliant files (834, 837, PDE, encounter), and supporting risk adjustment operations end\-to\-end. This role is critical in ensuring the accuracy, timeliness, and compliance of all healthcare data exchanged between Champion and external partners, including CMS, health plans, delegated groups, PBMs, and HIEs.
Primary Responsibilities
Manage secure data exchanges via SFTP, EDI, and flat file formats, including 834, 837, PDE, encounter, and eligibility files
Monitor and troubleshoot scheduled and ad hoc file transmissions
Reconcile data discrepancies and ensure timely issue resolution
Generate and transform data files to meet CMS and partner specifications
Use SQL, Excel, and scripting tools (Python or PowerShell) for data automation
Maintain documentation for file layouts, mapping logic, and data validation rules
Support CMS\-required submissions (PDE, MMR, HEDIS, RAPS, EDPS)
Prepare and validate encounter and risk adjustment data for accurate HCC capture
Reconcile risk score data and assist with correction and resubmission processes
Collaborate cross\-functionally on audit readiness and risk adjustment strategies
Ensure PHI/PII is handled in compliance with HIPAA and CMS data privacy regulations
Maintain audit logs, version control, and regulatory documentation
Coordinate with IT and Compliance on data governance and CMS updates
Qualifications
Required:
Minimum 3 years of experience in healthcare data integration, EDI, or CMS reporting
Hands\-on experience with Medicare Advantage data: 834, 837, PDE, RAPS, and EDPS
Strong proficiency in SQL and Excel; scripting experience in Python or PowerShell
Familiarity with file exchange tools such as Mirth Connect, GoAnywhere, etc.
Working knowledge of HIPAA and CMS regulatory requirements
Must be able to work full\-time on\-site in Long Beach, CA
Preferred:
Prior experience with a Medicare Advantage plan or delegated entity
Experience with CMS submission platforms (HPMS, CEM, EFT)
Exposure to Power BI or other data visualization/reporting tools
Strong organizational and problem\-solving skills
Ability to manage multiple priorities and meet strict deadlines
Job Type: Full\-time
Pay: From $80,000\.00 per year
Benefits:
401(k)
Dental insurance
Health insurance
Life insurance
Vision insurance
Schedule:
8 hour shift
Monday to Friday
Work Location: In person