Medicare Stars & Quality Program Analyst
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Job Description
Analyst supporting Capital Medicare Advantage Star Ratings Program analytics. Focused on improving or maintaining Medicare stars ratings through data-driven strategies and reporting.
Responsibilities:
- Analyze Medicare STARS performance metrics including HEDIS, CAHPS, HOS, and operational measures to identify trends, gaps, and opportunities.
- Lead or contribute to the forecasting of STARS ratings, using historical data, predictive modelling, and CMS methodology to project future performance.
- Translate STARS forecast insights into strategic initiatives to optimize performance and achieve targeted ratings.
- Collaborate with internal teams (Quality, Clinical, Operations, A&R, among others) to drive action plans based on performance and forecast data.
- Develop and maintain dashboards and performance tracking tools in Power BI and Excel to support ongoing monitoring and executive reporting.
- Write and optimize SQL queries to extract, manipulate, and analyze complex datasets from various sources.
- Use Python for automating data processing tasks, generating forecasts, and conducting advanced analyses as needed.
- Ensure accurate, timely reporting and alignment with evolving CMS requirements and regulatory updates.
- Support audits, internal reviews, and CMS data submissions with high attention to data quality and integrity.
- Collaborate with Actuarial to project and monitor the impact of the program on revenue for forecasting and financial statement accruals.
- Assist during the creation of processes, documentation, reporting infrastructure, SOPs, audits, etc.
Requirements:
- 3 + years of experience working in a Medicare Advantage setting, with a minimum of 2 years focused on STARS performance management
- Proficiency with Python SQL, MS Access, Excel, SAS, Power BI, and other query/reporting tools.
- Strong understanding of CMS STARS methodology, including HEDIS, CAHPS, HOS, and operational measures.
- Demonstrated experience with forecasting STARS performance, ideally using data models and predictive analytics.
- Vendor management, Project Management, and/or Quality Improvement experience.
- Prefer bachelor’s degree in data Analytics, Data Science, Finance, Actuarial, Mathematics or Statistics, Public Health, Health-related Sciences, Health Administration or Business Administration.
Benefits:
- Medical, Dental & Vision coverage
- Retirement Plan
- Generous time off including Paid Time Off
- Holidays
- Volunteer time off
- Incentive Plan
- Tuition Reimbursement
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