Medicare 5 Star Analyst

Fallon Health • Worcester, MA

4d

About The Position

The Medicare 5-Star Analyst supports Fallon Health's Medicare Star Ratings improvement strategy through advanced analytics, performance monitoring, reporting, forecasting, and operational consultation. The role is the organization's primary analytical resource for Medicare Star performance and works closely with Fallon Health's Stars analytics vendor, Hyperlift, to monitor performance projections, validate measure forecasts, identify improvement opportunities, and support strategic decision-making.

The Analyst serves as a subject matter expert on CMS Star Ratings, CAHPS, HOS, HEDIS, and related quality measures. In collaboration with organizational leaders, business owners, and measure stewards, the Analyst develops performance dashboards and exhibits, conducts trend analyses, identifies risks and opportunities, and provides recommendations to improve Medicare Star performance. The role uses trending and Star results to evaluate operational performance, monitor key performance indicators, quantify intervention effectiveness, and support enterprise-wide quality improvement initiatives. It translates complex data into business insights that support informed decisions and Fallon Health's Medicare performance goals.

Requirements

• Bachelor's degree in Healthcare Administration, Health Informatics, Data Analytics, Business, Public Health, Statistics, or a related field.
• Knowledge of Medicare Star Ratings methodology and performance measurement.
• Understanding of HEDIS, CAHPS, HOS, and CMS quality programs.
• Knowledge of healthcare operations, claims, enrollment, provider, and quality data.
• Understanding of performance measurement, KPI development, and benchmarking methodologies.
• Advanced analytical and critical-thinking skills.
• Ability to identify patterns, trends, risks, and opportunities within complex datasets.
• Strong problem-solving and root-cause analysis capabilities.
• Ability to develop forecasts and performance projections.
• Advanced Microsoft Excel skills.
• Experience with SQL and data extraction tools.
• Experience developing dashboards and visualization tools.
• Proficiency with Microsoft Office Suite.
• Ability to communicate complex technical information to non-technical audiences.
• Strong written and verbal communication skills.
• Ability to present findings to leadership and business stakeholders.
• Strong facilitation and collaboration skills.
• Demonstrated ability to independently identify, assess, and resolve complex problems; proactive self-starter with sound judgment and appropriate escalation practices.

Nice To Haves

• Master's degree in a related field.
• Lean Six Sigma certification.
• Project Management Professional (PMP) certification.
• Experience with healthcare reporting platforms.

Responsibilities

• Serve as the primary analytical resource supporting Fallon Health's Medicare Star Ratings strategy.
• Monitor and evaluate performance across all CMS Star measures.
• Develop and maintain internal dashboards, exhibits, and surveillance reports.
• Identify emerging performance risks, opportunities, and trends affecting Star Ratings outcomes.
• Track measure-level interventions and assess the effectiveness of improvement activities.
• Partner with business owners and department leaders to establish accountability and performance monitoring processes.
• Support annual Stars planning, goal setting, and performance reviews.
• Identify cultural trends, demographic patterns, disparities, and social determinants of health that may affect Medicare Star performance.
• Analyze provider practice patterns to identify performance variation, barriers, and improvement opportunities.
• Identify and define key performance indicators, establish accountability tracking, and lead routine performance reviews.
• Manage and participate in meetings across Medicare 5-Star domains, including agenda development, performance review, action tracking, and follow-up.
• Serve as the primary liaison between Fallon Health and Hyperlift for Medicare Stars analytics and reporting activities.
• Collaborate with Hyperlift to develop, validate, and interpret Star Ratings projections and forecast models.
• Monitor monthly and annual performance forecasts to identify potential risks and opportunities affecting Star outcomes.
• Evaluate projected measure performance and recommend intervention strategies to improve ratings.
• Validate vendor reporting outputs and reconcile forecasts with internal reporting and operational data.
• Partner with business owners and leadership to translate forecast results into actionable improvement plans.
• Participate in vendor meetings and oversee follow-up activities to support organizational objectives.
• Design, develop, maintain, and enhance operational and regulatory reports.
• Analyze large healthcare datasets to identify trends, patterns, and root causes.
• Create ad hoc analyses and executive presentations to support organizational decision-making.
• Validate data integrity and reconcile reporting outputs across multiple systems.
• Develop measures, KPIs, and analytical frameworks to evaluate business performance.
• Support predictive and trend analysis to identify future performance impacts.
• Partner with technical resources to define requirements and develop accurate, actionable reporting and analytical outputs.
• Develop alternative methods to obtain or approximate unavailable data, with appropriate validation, documentation, and disclosure of limitations.
• Collaborate with business owners to identify opportunities for operational improvement and translate analytical findings into actionable recommendations.
• Participate in root-cause investigations and corrective action planning.
• Support process improvement initiatives related to Star measures and quality performance.
• Provide analytical consultation for cross-functional projects impacting Medicare quality outcomes.
• Identify reporting efficiencies and automation opportunities.
• Conduct end-to-end reviews of processes supporting Medicare Star measures to identify gaps, dependencies, control weaknesses, and improvement opportunities.
• Participate in enterprise projects supporting Medicare, quality, compliance, and operational objectives.
• Assist leadership with strategic planning and performance improvement initiatives.
• Support implementation and testing of new reporting solutions and analytical tools.
• Perform additional duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level