Senior Medicare Stars Business Data Analyst
Work with measure data sources and business owners to identify and analyze key drivers of performance and support improvement initiatives by providing data insights.
Partner with other business areas to identify the best data sources for HEDIS, Administrative/Operations, Part D and CAHPS/HOS based Star measures.
Apply understanding of standard quality measures (e.
g.
, HEDIS, CAHPS, HOS) to identify additional strategic improvement levers (e.
g.
, supplemental data, benefits alignment) that may impact quality outcomes.
Extract data from electronic medical records, claims, HMSA Data Warehouse and other available sources.
Apply data analysis methods to identify trends and root cause and make recommendations based on results.
Monitor the quality of data extracts and identify and act upon opportunities for increasing automation, improving work-flows and procedures, and developing and/or revising clinical documentation.
Translate data and into actionable information using tables, graphs, charts, written reports and presentations.
Serve as Sightlines and Coreo subject matter expert for Stars team.
Maintain the Star Ratings dashboard to ensure that it accurately tracks performance against program goals.
Create and publish the Stars Dashboard and related metrics by the last business day of each month; supply actionable data to the Stars team and key operations areas to facilitate performance monitoring against targets, variance analysis, and year-end projections.
Review CMS Advance Notice for proposed changes affecting current and upcoming Star rating periods.
Notify Stars team and management of important proposed changes and the potential impact of the changes on HMSA's Star rating projection.
Participate in BCBSA calls to discuss changes to Star Ratings measures and rating methodology.
Provide HMSA's feedback to BCBSA on CMS's proposed changes to Star measures and rating calculations.
Review CMS Final Rate Announcement for changes in measures, methodology, and rating calculations that affect projection of HMSA's Star rating.
Inform Stars team of changes that impact the HMSA's Star rating.
Recalculate current Star rating projections based on changes and notify senior management of updated projections.
Advise appropriate areas of changes to measures and new measures so they can adjust their data collection and reporting process.
Setup Stars Dashboard at the beginning of each year to incorporate all CMS changes to measures, rating methodologies, and cut points.
Update glide paths, historical information, and calculations for each measure.
Add new measures and remove retired measures as outlined in the CMS Final Rate Announcement.
Revise formulas for overall rating, domain summaries, Part C & D summaries, and r-factor calculations.
Amend measure pages and summaries based on feedback from team and management.
Revise Stars Dashboard measure-level target thresholds, glide paths, and historical performance upon publication of the updated Star Rating Technical Notes in September/October of each year.
Evaluate new cut points for the upcoming Star year based on historical information for all Medicare contracts across the nation.
Facilitate the annual target setting discussion with Stars team and get a consensus on cut points and targets for each Star measure for the upcoming year.
Calculate overall target score to ensure our targets get us to desired Star score.
Setup, update, and monitor Display measure dashboard each year.
Alert team if there are significant changes in the performance of any of the Display measures.
Download Acumen reports, prepare the monthly Patient Safety reports, and email out to stakeholders Review HPMS memos from CMS and disseminate relevant information to Stars team and stakeholders.
Manage and/or participate in various projects and cross-departmental teams that support the Stars program.
Collaborate with other staff and management to complete assigned duties and objectives, facilitate communication, and resolve problems and issues quickly and positively.
Serve as the performance data subject matter expert for the Stars team in various workgroups and efforts (e.
g.
, data strategies, provider performance platforms such as Coreo, etc.
).
Write business requirements and test scripts, perform unit and system testing.
Coordinate and support Stars improvement activities with the HCC risk adjustment organization to ensure integration and alignment of quality goals with HCC risk adjustment objectives.
Participate in Blues plan and/or other industry work groups that support Star Rating improvement (e.
g.
FAST Network calls, surveys).
Network with other Blues plans across the nation to find out best practices for improving Star measures.
Participate in FAST Network efforts to share HMSA's data and view data from other Blues plans.
Other Duties/Functions:
Performs all other miscellaneous responsibilities and duties as assigned or directed.
#LI-Hybrid Recommended Skills Administration Automation Business Requirements Calculations Claim Processing Clinical Works Estimated Salary: $20 to $28 per hour based on qualifications.
Partner with other business areas to identify the best data sources for HEDIS, Administrative/Operations, Part D and CAHPS/HOS based Star measures.
Apply understanding of standard quality measures (e.
g.
, HEDIS, CAHPS, HOS) to identify additional strategic improvement levers (e.
g.
, supplemental data, benefits alignment) that may impact quality outcomes.
Extract data from electronic medical records, claims, HMSA Data Warehouse and other available sources.
Apply data analysis methods to identify trends and root cause and make recommendations based on results.
Monitor the quality of data extracts and identify and act upon opportunities for increasing automation, improving work-flows and procedures, and developing and/or revising clinical documentation.
Translate data and into actionable information using tables, graphs, charts, written reports and presentations.
Serve as Sightlines and Coreo subject matter expert for Stars team.
Maintain the Star Ratings dashboard to ensure that it accurately tracks performance against program goals.
Create and publish the Stars Dashboard and related metrics by the last business day of each month; supply actionable data to the Stars team and key operations areas to facilitate performance monitoring against targets, variance analysis, and year-end projections.
Review CMS Advance Notice for proposed changes affecting current and upcoming Star rating periods.
Notify Stars team and management of important proposed changes and the potential impact of the changes on HMSA's Star rating projection.
Participate in BCBSA calls to discuss changes to Star Ratings measures and rating methodology.
Provide HMSA's feedback to BCBSA on CMS's proposed changes to Star measures and rating calculations.
Review CMS Final Rate Announcement for changes in measures, methodology, and rating calculations that affect projection of HMSA's Star rating.
Inform Stars team of changes that impact the HMSA's Star rating.
Recalculate current Star rating projections based on changes and notify senior management of updated projections.
Advise appropriate areas of changes to measures and new measures so they can adjust their data collection and reporting process.
Setup Stars Dashboard at the beginning of each year to incorporate all CMS changes to measures, rating methodologies, and cut points.
Update glide paths, historical information, and calculations for each measure.
Add new measures and remove retired measures as outlined in the CMS Final Rate Announcement.
Revise formulas for overall rating, domain summaries, Part C & D summaries, and r-factor calculations.
Amend measure pages and summaries based on feedback from team and management.
Revise Stars Dashboard measure-level target thresholds, glide paths, and historical performance upon publication of the updated Star Rating Technical Notes in September/October of each year.
Evaluate new cut points for the upcoming Star year based on historical information for all Medicare contracts across the nation.
Facilitate the annual target setting discussion with Stars team and get a consensus on cut points and targets for each Star measure for the upcoming year.
Calculate overall target score to ensure our targets get us to desired Star score.
Setup, update, and monitor Display measure dashboard each year.
Alert team if there are significant changes in the performance of any of the Display measures.
Download Acumen reports, prepare the monthly Patient Safety reports, and email out to stakeholders Review HPMS memos from CMS and disseminate relevant information to Stars team and stakeholders.
Manage and/or participate in various projects and cross-departmental teams that support the Stars program.
Collaborate with other staff and management to complete assigned duties and objectives, facilitate communication, and resolve problems and issues quickly and positively.
Serve as the performance data subject matter expert for the Stars team in various workgroups and efforts (e.
g.
, data strategies, provider performance platforms such as Coreo, etc.
).
Write business requirements and test scripts, perform unit and system testing.
Coordinate and support Stars improvement activities with the HCC risk adjustment organization to ensure integration and alignment of quality goals with HCC risk adjustment objectives.
Participate in Blues plan and/or other industry work groups that support Star Rating improvement (e.
g.
FAST Network calls, surveys).
Network with other Blues plans across the nation to find out best practices for improving Star measures.
Participate in FAST Network efforts to share HMSA's data and view data from other Blues plans.
Other Duties/Functions:
Performs all other miscellaneous responsibilities and duties as assigned or directed.
#LI-Hybrid Recommended Skills Administration Automation Business Requirements Calculations Claim Processing Clinical Works Estimated Salary: $20 to $28 per hour based on qualifications.
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