Medicare STARS Analyst

Central Coast Salary Range:  $95,062 - $137,840 per year

Job Summary

The Quality Department is dedicated to improving health outcomes by enhancing the quality, safety, and equity of care delivered to our members through strong collaboration with providers and community organizations.

Reporting to the STARS Program Manager, the STARS Analyst supports analytic activities to optimize CenCal Health’s Medicare Stars rating performance. The position will help with HEDIS®[1], HOS, and overall analytics. Using data-driven insights, this role informs strategic initiatives, audit readiness, and interventions to sustain or improve quality metrics. The STARS Analyst will aid in the design of targeted interventions for performance improvement and the periodic projections of CenCal Health’s STAR metric performance under a variety of future scenarios. This analytic work will be leveraged across the organization to help guide the high-stakes quality improvement activities led by various teams. Through continued drilldown analyses, monitoring performance and maintenance of projection models, the STARS Analyst will also have responsibilities to maintain, update, and refine CenCal Health’s analytic approach as the plan evaluates the potential impacts key activities might have on CenCal Health’s overall scores.

This position will collaborate with the Quality Department staff, IT analytics teams, and the Medicare STARS Program Manager to define business needs in improving care management.

Duties & Responsibilities

Data Infrastructure and Management of STARS reporting platform

• Collaborate with Information Technology programming staff and Quality Measurement Team to ensure the accurate capture and integration of data into NCQA HEDIS® and STAR reporting Software.
• In collaboration in Quality Measurement Team, configure, validate, and maintain data files required for NCQA HEDIS® submissions, gaps in care, and pay-for-performance reporting, and Model of Care reporting requirements.
• Identify and implement process improvements to enhance data workflows, increase operational efficiency, and reduce manual effort.

Data Analytics and Reporting

• Conduct monitoring of Medicare STAR component measures (HEDIS®, HOS, CAHPS, Pharmacy, etc.) and identify performance trends and gaps.
• Build and maintain projection models to forecast STAR performance under various business scenarios.
• Maintain design actionable dashboards and analytic deliverables to assist stakeholders across the organization track performance of access to care, clinical quality and consumer experience metrics and to predict the performance trending in Medicare population.
• Develop analytic plans and solutions to track performance trending of patient access to care, clinical quality and consumer experience among Medicare population.
• Develop and maintain analytics to support model of care quality performance monitoring, including tracking metrics required for reporting to the Centers for Medicare and Medicaid (CMS) and evaluating the effectiveness of interventions for special needs populations.
• Continuously refine analytic methodologies and tools to improve the accuracy, timeliness, and usability of reporting.

Quality Improvement Support

• Provide dedicated analytical support within the Quality Department, including but not limited to designing and creating SQL data extract queries to identify healthcare disparities and monitor the effectiveness of targeted interventions.
• Support the design, configuration, and maintenance of quality measurement tools, including, to ensure effective oversight of CenCal Health’s Quality Improvement and Health Equity Transformation Program, pay-for-performance programs, and Model of Care monitoring goals.
• Participate in audit preparation and readiness; maintain audit readiness and documentation for regulatory and accreditation activities.
• Recommend and implement enhancements to data capture, metric tracking, and intervention evaluation processes to better support quality improvement.

Stakeholder Engagement and Communication

• Present analysis results to internal decision-makers and cross-functional stakeholders, often creating informative business metrics to influence decision makers.
• Translate technical analytic results into clear findings and recommendations.
• Assist in the development and implementation of solutions to meet ongoing strategic objectives.
• Collaborate with multidisciplinary teams to gather feedback and adapt processes for greater impact and efficiency.

Other Duties:

• Engage in relevant committees, workgroups or workstreams, and cross-functional projects as assigned.

Knowledge/Skills/Abilities

Required:

• Deep understanding of Medicare STAR Rating methodology.
• Demonstrate superior proficiency in Excel.
• Demonstrate basic proficiency in SQL.
• Experience mapping business needs to analytics planning and technical requirements.
• Experience handling large, structured and unstructured data sets.
• Proficiency designing dashboards and evaluating performance interventions.
• Ability to independently execute projects with multiple business stakeholders on firm deadlines.
• Strong teamwork and ability to solve data and analytics problems through communication and collaboration.
• Excellent written and verbal communication skills, with the ability to present complex analytics concisely, and make recommendations in verbal, written and presentation formats across varied audiences.
• Perform effectively under pressure and maintain focus on both daily responsibilities and long-term projects.
• Possess knowledge of medical record systems, including the collection of data from hardcopy records, various EMR systems, and supplemental data sources (e.g., HIE).
• Evaluate data, draw conclusions, and establish facts to guide decision-making.
• Provide and receive constructive, timely feedback to team members, peers, and supervisors.
• Exhibit strong oral and written communication and negotiation skills.

Desired:

• Knowledge of NCQA Accreditation standards.

Education & Experience

Required:

• Bachelor’s Degree in Public Health, Healthcare Administration, Health Informatics, Data Analytics, or related field.
• Three (3) years of experience in reporting and analyzing quality improvement measures.
• Three (3) years of expertise in Stars (HEDIS®, HOS, CAHPS).
• Experience working in Medicare managed care.
• Proficiency in Microsoft Excel, with strong skills in data manipulation and interpretation.

Desired:

• Graduate degree in healthcare or data-focused discipline.
• Experience with Medicaid or dual-eligible populations.
• Experience with NCQA Accreditation surveys.