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.

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Medicare Business Data Analyst

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