Senior Medicare Data Analyst

San Francisco Health Plan • San Francisco, CA

284d • $90,000 - $110,000 • Hybrid

About The Position

Reporting to the Manager of Quality Data Analytics, the Senior Medicare Data Analyst will support the Quality Improvement Population Health Management Team in driving excellence in D-SNP reporting, STAR Ratings, and regulatory compliance. You will be responsible for overseeing data management, analysis, and reporting to meet CMS Medicare Advantage Prescription Drug (MAPD) program requirements and improve Part C and Part D performance measures. SFHP is proud to offer a hybrid work environment. This role will be required to be in-office, onsite, a minimum of 4 days per month.

Requirements

• Bachelor's degree in Data Analytics, Health Informatics, Public Health, Statistics, or equivalent relevant work experience.
• 3 to 5 years of experience in CMS STAR Ratings methodologies and healthcare performance analytics, Medicare Advantage, D-SNP, Quality programs, and MAPD data reporting.
• Proficiency in SQL, SAS, Python, R, or other data analysis tools.
• Experience working with large healthcare datasets (claims, encounter, HEDIS, CAHPS, HOS, PDE, Lab, EHR).
• Familiarity with technologies such as Cotiviti's Star Intelligence and Quality Reporter, QNXT or Jiva.
• Familiarity with CMS reporting requirements, regulatory policies, and risk adjustment methodologies.
• Analytical skills with experience in data visualization tools (Tableau, Power BI).
• Knowledge of Medicare and Medicaid integration, care models, and population health analytics.

Responsibilities

• Lead the collection, validation, and analysis of data related to D-SNP quality measures, STAR Ratings, and Part C & Part D reporting.
• Develop and maintain standardized reports and dashboards to track STAR Rating performance and compliance metrics.
• Interpret and apply CMS guidance related to quality reporting, ensuring data accuracy and regulatory adherence.
• Collaborate with team members to support data-driven decision-making and performance improvement initiatives.
• Support the submission of CMS-required data files and reports, ensuring accuracy.
• Conduct trend analyses, predictive modeling, and gap assessments to identify opportunities for improving D-SNP performance measures.
• Help develop business rules and methodologies for quality measure calculations and reporting.
• Work with clinical staff, IT and data teams to ensure data integrity, extraction processes and automation of reporting systems and external partners such as providers and regulatory agencies.
• Monitor industry changes to CMS methodologies, technical specifications, and guidance documents related to STAR Ratings and D-SNP requirements.
• Provide analytical support for quality improvement projects, audits, and strategic planning efforts.

Benefits

• Health Benefits
• Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.
• Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
• Vision: Employee vision care coverage is available through Vision Service Plan (VSP).
• Retirement - Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.
• Time off - 23 days of Paid Time Off (PTO) and 13 paid holidays.
• Professional development: Opportunities for tuition reimbursement, professional license/membership.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree