Medicare Advantage Stars Data Analyst

🕒 Setembro 22

🦀 Maryland – Remoto

🦀 Maryland – Remote

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

📉 Analista de Dados

👻 Score fantasma 13%

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Medisolv, Inc.

SiteLinkedInTodas as Vagas

51 - 200 funcionários

Fundada em 1999

🏥 Saúde

☁️ SaaS

🤝 B2B

💰 Private equity em 2023-06

Healthcare • SaaS • B2B

A Medisolv é uma empresa de análise e medição de qualidade em saúde que oferece uma plataforma de software e serviços desenvolvidos especialmente para ajudar hospitais e sistemas de saúde a atender aos requisitos de relatórios regulatórios e melhorar o desempenho clínico. Suas ofertas incluem pacotes de relatórios focados em conformidade para CMS e a Comissão Conjunta (eCQMs hospitalares, medidas abstratas/híbridas/PRO-PM), relatórios de MIPS e MVP em nível de clínico, relatórios de ACO/APP, e análises de desempenho através do produto QualityIQ. A Medisolv também oferece serviços de consultoria/assinatura de melhoria de qualidade avançada (AQI), ferramentas de benchmarking (por exemplo, analisador de classificação por estrelas de hospital) e um centro de recursos para clientes/comunidade para apoiar a melhoria contínua da qualidade.

Descrição

• Serve as subject matter expert on CMS Stars measures, specifications, and methodology, including denominators, numerators, exclusions, benchmarks, and cut points • Understand and analyze transformation of claims, HEDIS, CAHPS, HOS, supplemental feeds, and other data into measure-level Stars performance • Track CMS methodology changes and keep analytical products aligned • Define data ingestion requirements and map source data into standardized structures, specifications, and data dictionaries • Identify and resolve ingestion data-quality issues by validating completeness, accuracy, and consistency • Monitor data movement through ETL/ELT into warehouses, marts, and reporting layers • Design Stars data marts and analytical models, including fact tables, dimensions, and calculated fields • Model relationships between 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 • Perform year-over-year analysis of measure performance and Star Rating implications • Build reporting specifications and dashboards for plan leaders • Build and maintain Power BI, Tableau, or similar dashboards with reusable measures, calculations, and visualizations • Define reporting standards and best practices for Stars analytics • Work with Medicare Advantage health plans to understand data, reporting needs, and analytics questions • Reconcile internal plan reporting with external analytics and investigate discrepancies • Present findings to plan quality, analytics, and business teams • Develop data validation, reconciliation, and automated quality-check processes • Compare source, transformed, and reported data to investigate discrepancies or unexpected changes • Partner with engineering to resolve defects and validate new feeds or methodology changes • Translate requirements into data specifications, user stories, and test cases • Participate in product development from requirements through testing and deployment • Automate manual processes and contribute to new Stars data products • Independently own a Stars data product or reporting deliverable end-to-end and work directly with health plan stakeholders

🎯 Requisitos

• Bachelor's degree in data analytics, computer science, health informatics, healthcare administration, mathematics, statistics, business, or a related field • 5+ years of healthcare data experience, including direct work with Medicare Advantage Stars data and strong understanding of CMS Stars measures and methodology • Experience with data ingestion, transformation, warehouses, marts, and analytical databases • Strong SQL skills and ability to work from database schemas across multiple healthcare data sources • Experience developing reports and dashboards using Power BI, Tableau, or comparable BI tools • Strong data validation, reconciliation, and problem-solving skills • Ability to work directly with health plan stakeholders and translate business questions into analytical requirements • Strong communication skills for technical and non-technical audiences • Experience with Medicare Advantage health plans, healthcare technology companies, consulting organizations, or Stars analytics vendors preferred • Experience with Stars-specific data marts, CMS Stars data submissions, reports, technical specifications, or methodology 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 with data visualization and dashboard development in Power BI or Tableau preferred • Familiarity with healthcare data standards and common MA data structures preferred • Experience working in Agile product environments with software engineers and data engineering teams preferred • Must successfully pass a pre-employment background check • Must be legally authorized to work in the United States; sponsorship is not available

🏖️ Benefícios

• Fully remote work arrangement • Diverse and inclusive workplace • Pre-employment background check • Healthcare quality and analytics-focused work environment