Medicare Business Data Analyst
About The Position
The Medicare Business Data Analyst develops reports, dashboards, and analyses to support Stars and Risk Adjustment performance improvement initiatives. The role integrates data from internal and external sources, applies advanced analytical methods, identifies trends and root causes, and translates findings into actionable visualizations, reports, and presentations for internal and external partners. It also supports data quality controls, regulatory compliance, Medicare quality initiatives, and member incentive programs. The analyst monitors Medicare Part C and D Star Ratings and Risk Adjustment performance, tracks changes and potential performance risks, publishes monthly dashboards and metrics, validates CMS performance reports against internal data, and supports ad hoc reporting. The role also researches and develops data automation across disparate systems, documents data and workflow requirements, and collaborates with cross-functional quality, risk adjustment, provider, and industry teams. The position includes other responsibilities as assigned or directed.
Requirements
- Bachelor's degree in information systems, data analytics, mathematics, or statistics and four years of related work experience, or an equivalent combination of education and related work experience.
- Demonstrated knowledge of identifying issues, collecting data, and analyzing and interpreting data.
- Knowledge of managed care or health care business processes, systems, and applications for delivered services such as claims, encounters, provider data, and/or patient or member data.
- Intermediate working knowledge of Microsoft Word, PowerPoint, and Outlook.
- Advanced working knowledge of Microsoft Excel.
- Intermediate working knowledge of MicroStrategy, SQL, SAS, Access, R, or other business intelligence languages or tools.
- Intermediate working knowledge of Tableau or other data visualization tools.
Responsibilities
- Develop and present reports with insights and action plans for Stars and Risk Adjustment performance improvement initiatives.
- Integrate data and use analytical methods and tools to identify trends, issues, root causes, and population segments; communicate findings through visualizations, written reports, and presentations.
- Develop, implement, or enhance methods for extracting complex data sets from available sources.
- Apply knowledge of quality measures such as HEDIS, CAHPS, and HOS to identify improvement levers that may affect Stars performance.
- Apply knowledge of RAF and HCC to identify improvement levers for Risk Adjustment.
- Ensure Stars measure and Risk Adjustment data are complete and accurate through controls and validation activities.
- Contribute to an agile quality team supporting quality improvement initiatives, Medicare quality pilot programs, and member incentive programs.
- Ensure compliance with regulatory standards and requirements.
- Maintain understanding of Medicare Part C and D Star Ratings Technical Notes, RAF, and HCC; monitor proposed changes and identify performance risks and mitigation strategies.
- Gather data and create and publish monthly Stars and Risk Adjustment dashboards and metrics; support acquisition of new data sources.
- Create and update committee and program-team reports, distributing actionable data for monitoring performance against targets and year-end projections.
- Work with internal and external teams to identify and implement dashboard enhancements.
- Validate CMS Stars plan performance reports, including First Plan Preview and Westat MCAHPS reports, against internal data.
- Support ad hoc Stars and Risk Adjustment reporting requests.
- Research, design, and develop data automation between disparate systems through interfaces, APIs, ETLs, or other technological solutions.
- Collaborate on project teams to understand, research, and document requirements for data, workflows, and business needs.
- Progress assigned work independently according to timelines and deadlines, and collaborate to ensure projects meet defined requirements.
- Participate in projects and cross-departmental teams supporting the Stars program and Risk Adjustment.
- Serve as the Stars and Risk Adjustment performance data subject matter expert in workgroups and efforts, including data strategies, HEDIS performance, and provider performance platforms.
- Coordinate Stars performance data activities with related quality teams and align Stars improvement activities with the HCC risk adjustment team.
- Represent HMSA in Blues plan and other industry workgroups to compare best practices for improving Stars performance data.
- Perform other miscellaneous responsibilities and duties as assigned or directed.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
