Senior Medicare Advantage Stars Analyst | CMS Quality & Performance - Hybrid

Fallon Health•Worcester, MA

7d•$125,000 - $130,000•Hybrid

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 with its Stars analytics vendor, Hyperlift, to monitor projections, validate forecasts, identify improvement opportunities, and inform strategic decisions. The analyst serves as a subject matter expert on CMS Star Ratings, CAHPS, HOS, HEDIS, and related quality measures. Working with organizational leaders, business owners, and measure stewards, the analyst develops dashboards and exhibits, analyzes trends, identifies risks and opportunities, and recommends actions to improve Medicare Star performance. The role uses measure results and trend data to evaluate operations, monitor KPIs, assess interventions, 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 and claims, enrollment, provider, and quality data.
Understanding of performance measurement, KPI development, and benchmarking methodologies.
Advanced analytical and critical-thinking skills, including the ability to identify patterns, trends, risks, and opportunities in 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 using visualization tools.
Proficiency with Microsoft Office Suite.
Ability to communicate complex technical information to non-technical audiences.
Strong written and verbal communication skills and ability to present findings to leadership and business stakeholders.
Strong facilitation and collaboration skills.
Ability to independently identify, assess, and resolve complex problems; proactive self-starter with sound judgment and appropriate escalation practices.
Authorization to work in the United States; Fallon Health cannot provide employment-based visa sponsorship now or in the future.

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 and monitor performance across CMS Star measures.
Develop and maintain internal dashboards, exhibits, surveillance reports, operational reports, and regulatory reports.
Identify emerging performance risks, opportunities, and trends affecting Star Ratings outcomes.
Track measure-level interventions and evaluate 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, strategic planning, 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.
Define KPIs, 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 with Hyperlift for Medicare Stars analytics and reporting.
Collaborate with Hyperlift to develop, validate, and interpret Star Ratings projections and forecast models.
Monitor monthly and annual forecasts, evaluate projected measure performance, and recommend intervention strategies.
Validate vendor reporting outputs and reconcile forecasts with internal reporting and operational data.
Translate forecast results into actionable improvement plans with business owners and leadership.
Participate in vendor meetings and oversee follow-up activities.
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, analytical frameworks, and predictive or trend analyses to evaluate business performance and future impacts.
Partner with technical resources to define requirements and produce accurate, actionable reports and analyses.
Develop alternative methods to obtain or approximate unavailable data, validating and documenting methods and disclosing limitations.
Translate analytical findings into business recommendations and participate in root-cause investigations and corrective action planning.
Support process improvement initiatives and provide analytical consultation for cross-functional projects affecting Medicare quality outcomes.
Identify reporting efficiencies and automation opportunities.
Review end-to-end 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.
Support implementation and testing of reporting solutions and analytical tools.
Perform additional duties as assigned.