Medicare Business Data Analyst

• Report Development, Research and Analysis:

• Develop and present reports that provide organizational awareness, insights and action plans to internal and external partners supporting Stars and Risk Adjustment performance improvement initiatives.

• Integrates data and uses advanced analytical methods/tools to identify trends, issues, root causes and focused population segments, translating data into actionable visualizations using tables, graphs, charts, written reports and presentations.

• Develops, implements and/or enhances methods to extract complex data sets from available sources (e.g., HMSA data repositories, HEDIS software, external party extracts, etc.).

• Applies understanding of standard quality measures (e.g., HEDIS, CAHPS, HOS) to identify strategic improvement levers (e.g., supplemental data, benefit alignment) to impact Stars performance.

• Applies understanding of Risk Adjustment Factor (RAF) and Hierarchial Care Conditions (HCC) to identify strategic improvement levers to improve Risk Adjustment

• Ensures Stars measure data and Risk Adjustment data is complete and accurate by implementing effective controls and validation activities.

• Work as part of an agile quality team supporting quality improvement initiatives, Medicare quality pilots programs and member incentive programs.

• Ensure compliance to regulatory standards and requirements

•  Stars and Risk Adjustment Performance Monitoring

• Maintains a thorough understanding of the Medicare Part C & D Star Ratings Technical Notes, Risk Adjustment Factor (RAF) and Hierarchical Care Conditions (HCC). Monitor proposed changes, proactively identify potential risks to performance, as well as associated mitigation strategies.

• Gathers data to create and publish Stars and Risk Adjustment dashboards and related metrics on a monthly basis. Proactively identifies and supports acquisition of new data sources.

• Create and update reports for committees and other program-related teams, distributes actionable data to facilitate performance monitoring against current targets and year-end projections.

• Works with internal and external teams to proactively identify and implement Stars and Risk Adjustement dashboard enhancements.

• Validates CMS Stars plan performance reports (e.g., First Plan Preview, Westat MCAHPS reports) against internal data.

• Suports ad hoc reporting requests for Stars and Risk Adjustment

•  Data Automation and Streamlining

• Reasearch, design and develop data automation between disparate data systems through interfacing, APIs, ETLs, or other technological solutions.

• Work collaboratively as part of project teams to understand, research and document requirements for data, workflows, and business needs.

• Works independently to progress assigned work according to timeline and deadlines, work collaboratively to ensure that projects are meeting defined requirements.

•  Cross-Functional Collaboration

• Participates in projects and cross-departmental teams that support the Stars program and Risk Adjustment.

• Serves as the Stars and Risk Adjustment performance data subject matter expert in various workgroups and efforts (e.g., data strategies, HEDIS performance, provider performance platforms such as Cozeva, Cotiviti etc.).

• Coordinates Stars performance data activities with related quality team activities (e.g., HEDIS data team, Primary Care Payment Model quality team, FQHC/RHC quality team). Coordinates Stars improvement activities with the HCC risk adjustment team to ensure integration and alignment of quality goals with HCC risk adjustment objectives.

• Represents HMSA in Blues plan and/or other industry work groups to compare best practices for improving Stars performance data. 

•  Performs all other miscellaneous responsibilities and duties as assigned or directed.

 

 

#LI-Hybrid

Qualifications

• Bachelor's degree in information systems, data analytics, mathematics or statistics and four (4) years of related work experience; or equivalent combination of education and related work experience.

• Demonstrated knowledge in identifying issues, collecting data, and analyzing and interpreting data.

•  Knowledge of managed care/health care business processes, systems and applications for delivered services such as claims, encounters, provider data, and/or patient/member data.

•  Intermediate working knowledge of Microsoft Office applications including Word, PowerPoint and Outlook.

• Advanced working knowledge of Microsoft Excel.

•  Intermediate working knowledge of MicroStrategy, SQL, SAS, Access, R or other business intelligence language/tools.

•  Intermediate working knowledge of Tableau or other data visualization tools.