Senior Analyst, Medical Economics – Stars and Risk Adjustment

🕒 Maio 12

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Monogram Health

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 2019

⚕️ Seguro de Saúde

🤝 B2B

👥 B2C

Healthcare Insurance • B2B • B2C

A Monogram Health é uma provedora líder em especialidades múltiplas que oferece atendimento domiciliar baseado em evidências e gerenciamento de benefícios para pacientes com condições crônicas complexas e múltiplas, com forte foco em doença renal crônica e nas necessidades relacionadas à saúde metabólica, cardiovascular, pulmonar e comportamental. A empresa coordena equipes clínicas de especialidades múltiplas (nefrologia, cardiologia, endocrinologia, pneumologia, saúde comportamental e cuidados paliativos), fornece suporte domiciliar 24 horas por dia, incluindo diálise domiciliar e gerenciamento de medicamentos, e faz parcerias com pagadores e grupos de médicos para melhorar os resultados, reduzir hospitalizações e diminuir os custos.

Descrição

• Develop and maintain standardized Stars and Risk Adjustment reporting using internal data sources and CMS files within Databricks and Power BI • Lead code development and end-user dashboard creation, applying subject-matter expertise to meet defined business needs • Serve as a subject matter expert on Risk Adjustment data sources, including MAO-004, 837, MMR, and MOR files • Present internal overviews and detailed analytical findings to stakeholders to ensure alignment and clarity on next steps • Analyze data to identify trends, performance opportunities and develop actions plans to address gaps • Build a deep understanding of clinical workflows and collaborate to enhance processes that support departmental efficiency and effectiveness • Partner with internal teams to share insights that may influence underwriting, contracting, operations and other business areas • Support the growth of direct and matrixed team members by fostering knowledge‑sharing and sustainable progress toward departmental goals

🎯 Requisitos

• Bachelor’s degree required; Master’s degree in healthcare or a related field, or actuarial certification (FSA/ASA in progress of completed) preferred • Minimum of two (2) years of experience in Medicare Advantage Stars or Risk Adjustment analytics • Proficiency in SQL, R, and Python; experience working with large enterprise data warehouses; strong ability to build, modify and optimize data tables; intermediate-to-advanced Power BI skills, including complex DAX and data modeling • Knowledge of CMS Risk Adjustment and Stars data sources (MAO-004, 837, MMR, MOR) • Ability to translate data into clear, actionable insights • Communication skills and ability to collaborate in a matrixed environment and influence others to drive outcomes

🏖️ Benefícios

• Comprehensive Benefits - Medical, dental, and vision insurance, employee assistance program, employer-paid and voluntary life insurance, disability insurance, plus health and flexible spending accounts • Financial & Retirement Support – Competitive compensation, 401k with employer match, and financial wellness resources • Time Off & Leave – Paid holidays, flexible vacation time/PSSL, and paid parental leave • Wellness & Growth – Work life assistance resources, physical wellness perks, mental health support, employee referral program, and BenefitHub for employee discounts