Job description

• 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. #LI-Hybrid • Bachelor's degree in information systems, data analytics, mathematics or statistics and four (4) years of related work experience; or equivalent combination of education and related work experience. • Demonstrated knowledge in identifying issues, collecting data, and analyzing and interpreting data. • Knowledge of managed care/health care business processes, systems and applications for delivered services such as claims, encounters, provider data, and/or patient/member data. • Intermediate working knowledge of Microsoft Office applications including Word, PowerPoint and Outlook. • Advanced working knowledge of Microsoft Excel. • Intermediate working knowledge of MicroStrategy, SQL, SAS, Access, R or other business intelligence language/tools. • Intermediate working knowledge of Tableau or other data visualization tools.

Requirements

Must-haves

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.
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
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.).
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.
Bachelor's degree in information systems, data analytics, mathematics or statistics and four (4) years of related work experience; or equivalent combination of education and related work experience.
Demonstrated knowledge in identifying issues, collecting data, and analyzing and interpreting data.

Nice-to-haves

None flagged.

Application prep

Use the role’s language and application details while tailoring your materials.

Keywords to mirror

agilesql

Platform: adp-recruiting
Effort: medium