Job Summary:
The Enterprise Stars Analyst functions as the primary Stars subject matter expert, responsible for supporting the strategy for the Medicare Star Ratings Program, developing comprehensive reporting, providing analytical insights and making recommendations to business partners to inform program changes.
Essential Functions:
- Develop and update Star Ratings logic requirements, MMP Quality Withhold & Penalty reporting and analysis
- Lead Star Ratings projection analysis and provide business analytics and data to impact performance improvement on Stars Ratings.
- Analyze data to identify insights and opportunities for performance improvements, assess effectiveness of interventions and deliver actionable recommendations for performance improvement.
- Ensure compliance with Star Ratings (DSNP and QRS) and MyCare CMS/ODM specifications, policies, operating procedures, and goals in compliance with internal and external guidelines
- Collaborate with business areas and other stakeholders to prioritize, design, and implement initiatives and innovations which will increase Star Ratings and MMP Penalty/Quality withhold payout
- Support the organization as a Subject Matter Expert of Star Ratings (MA Stars and Marketplace QRS), FIDE/HIDE SNP, MMP CMS Quality & Ohio Penalty measures, CAHPS and other performance measure technical specifications
- Identify and close data collection gaps and opportunities to increase performance outcomes
- Maintain detailed understanding of nuances of Stars performance across different markets and help develop strategies and programs to match those needs.
- Drive goal setting across all contracts and help prioritize when interventions are required
- Serve as a quality expert with internal constituents to drive Star-related program development and outcomes success.
- Create and update reports utilizing the most recent specifications on Improvement Factor, Risk Adjustment, Categorical Adjustment, as well as Star domain/chapter categorization. Utilize year over year trends and perform Star calculations and predictive analytics
- Update measure rates and perform quality assurance checks with measure gap reports; track measures against company and national NCQA/PQA targets
- Utilize the business intelligence enterprise system software development suite to create, maintain and publish reports, dashboards, scorecards, and other visual information displays through front end interfaces as well as through application and database programming
- Partner with Quality teams and other business stakeholders to develop unique and innovative graphics-based business intelligence solutions that deliver actionable information to the business.
- Ensure dashboards, data models, and report templates are aligned with overall system functionality and business owner requests
- Adhere to proper coding, testing and documentation of standards, business logic, and IT change control processes and procedures
- Support required analytics and reporting for quality analytics team and provide technical expertise where necessary and required.
- Perform other job related duties as assigned
Education and Experience:
- Bachelor's degree or equivalent year of relevant work experience is required
- Minimum of five (5) years of experience in data analysis is required
- Minimum of five (5) years of Medicare Star Ratings experience is required
- Minimum of three (3) years of experience using SQL is required
- Project Management experience is preferred
Competencies, Knowledge and Skills:
- Exceptional analytical, problem solving and critical thinking skills
- Programming knowledge of SQL is required at an intermediate or advanced level
- Demonstrated ability in identifying problems, developing solutions and implementing effective courses of action.
- Strong communication skills required, including the abilities to effectively communicate verbally and in writing, internally and externally, and at different levels as necessary.
- Demonstrated ability to work effectively and productively with varied levels of personnel, with professionals and business organizations.
- Demonstrated critical thinking, problem solving, and time management skills are required.
- Ability to multi-task, problem-solve and work independently and collaboratively
- Strong service orientation and consulting skills
- Ability to lead mission-critical, high visibility projects
- Proven ability to juggle multiple complex priorities within a changing environment
- Strong knowledge MS Office and Project Management tools
Licensure and Certification:
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$79,800.00 - $127,600.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
