Medicare Advantage Stars Data Analyst

This is a fully remote position, open to applicants in Maryland.

📋 Description

• Act as a subject matter expert on CMS Stars measures, specifications, and methodologies, including denominators, numerators, exclusions, benchmarks, and cut points.

• Comprehend and evaluate the transformation of claims, HEDIS, CAHPS, HOS, supplemental feeds, and other data into measure-level Stars performance.

• Monitor changes in CMS methodology and ensure alignment of analytical products.

• Specify data ingestion requirements and map source data into standardized structures, specifications, and data dictionaries.

• Detect and resolve data quality issues related to ingestion by validating completeness, accuracy, and consistency.

• Oversee the movement of data through ETL/ELT processes into warehouses, marts, and reporting layers.

• Design Stars data marts and analytical models, including fact tables, dimensions, and calculated fields.

• Model relationships among members, providers, claims, and quality events.

• Validate data marts and models against CMS requirements and source data.

• Analyze Stars performance by plan, contract, measure, and provider, identifying trends, gaps, and anomalies.

• Conduct year-over-year analyses of measure performance and implications for Star Ratings.

• Develop reporting specifications and dashboards for plan leadership.

• Create and manage dashboards in Power BI, Tableau, or similar tools, incorporating reusable measures, calculations, and visualizations.

• Establish reporting standards and best practices for Stars analytics.

• Collaborate with Medicare Advantage health plans to understand their data, reporting needs, and analytical inquiries.

• Reconcile internal plan reports with external analytics and investigate any discrepancies.

• Present findings to teams focused on quality, analytics, and business operations.

• Create processes for data validation, reconciliation, and automated quality checks.

• Compare source, transformed, and reported data to investigate discrepancies or unexpected variations.

• Partner with engineering teams to resolve defects and validate new data feeds or methodological changes.

• Translate requirements into data specifications, user stories, and test cases.

• Engage in product development from requirements gathering through testing and deployment.

• Automate manual processes and contribute to the development of new Stars data products.

• Take full ownership of a Stars data product or reporting deliverable from start to finish, collaborating directly with health plan stakeholders.

⛳️ Requirements

• Bachelor's degree in data analytics, computer science, health informatics, healthcare administration, mathematics, statistics, business, or a related field.

• Over 5 years of experience in healthcare data, including direct involvement with Medicare Advantage Stars data and a solid grasp of CMS Stars measures and methodologies.

• Proficiency in data ingestion, transformation, warehouses, marts, and analytical databases.

• Strong SQL skills and the ability to work with database schemas across various healthcare data sources.

• Experience in developing reports and dashboards using Power BI, Tableau, or similar business intelligence tools.

• Excellent skills in data validation, reconciliation, and problem-solving.

• Capability to work directly with health plan stakeholders and translate business inquiries into analytical requirements.

• Strong communication skills suitable for both technical and non-technical audiences.

• Preferred experience with Medicare Advantage health plans, healthcare technology firms, consulting organizations, or Stars analytics vendors.

• Preferred experience with Stars-specific data marts, CMS Stars data submissions, reports, technical specifications, or methodologies.

• Preferred experience with HEDIS, CAHPS, HOS, claims, encounters, pharmacy, enrollment, provider, supplemental, and other MA data sources.

• Preferred experience with ETL/ELT pipelines and cloud data platforms such as Snowflake, Databricks, Azure, or AWS.

• Preferred experience in data visualization and dashboard development using Power BI or Tableau.

• Familiarity with healthcare data standards and common MA data structures is preferred.

• Preferred experience working in Agile product environments alongside software engineers and data engineering teams.

• Must successfully complete a pre-employment background check.

• Must be legally authorized to work in the United States; sponsorship is not available.

🏝️ Benefits

• Fully remote work arrangement.

• Diverse and inclusive workplace culture.

• Required pre-employment background check.

• Work environment focused on healthcare quality and analytics.