Medicare Stars Analyst - Care N Care Insurance Company of North Carolina

JOB SUMMARY

Reporting to the Senior Manager, Quality/Medicare Stars, this individual will play a critical role in executing HealthTeam Advantages’ Quality programs with the implementation of the National Committee for Quality Assurance (NCQA) and Centers for Medicare & Medicaid Services (CMS) compliant Stars functions, projects, roadmap development, reporting, audit, and submissions. This position will provide oversight, direction, and assistance to the delegated partners responsible for provider communications, quality programming, abstracting data, formatting data, and submitting data to ensure that data submitted is accurate and meets all CMS deadlines. The Medicare Stars Analyst will lead implementation strategies to achieve desired quality outcomes and Star measures.  

ESSENTIAL DUTIES AND RESPONSIBILITIES

This position must be able to:

• Responsible for the annual development and implementation of the Plan’s Star Quality Plan to include coordination/tracking of each Star requirement per CMS’s technical specifications across multiple contracts.
• Proactively manage and work with Stars program management team, health plan and provider leadership to develop and execute Stars strategy; think strategically and translate business strategy into initiatives.
• Responsible for analyzing, compiling, and validating Stars related data in compliance with national, federal, state, and certification requirements.
• Responsible for the tracking of Star measures through HEDIS software, HPMS and other reporting platforms, including identifying/resolving issues related to process, data, and/or Stars program.
• Ensures effectiveness of Stars programs by working across the organization and its providers, leading work plan meetings and conducting regular deep dives with functional teams to ensure initiatives are directly aligned with Star measure improvement.
• Independently, or in teams, apply analytics programs/tools to develop and execute complex, ad-hoc analysis of clinical, claims, and other data to surface insights regarding plans multiple contracts and multi-year performance.
• Project manage the collaboration with operations, delegated partners, and external vendors for the development and implementation of Star related activities.
• Plan lead for Star related initiatives including member outreach campaigns, Health Fair management, member identification, implementation, and execution.
• Collaborates across the Plan and with vendors to identify areas of educational need internally and externally.
• Independently, or in teams, produce, interpret and explain reports monthly and as needed to support generating actionable outcomes for Plan quality initiatives.

EDUCATION AND EXPERIENCE

Education:

• College Degree
• Bachelor’s Degree or additional four (4) or more years equivalent work experience

Required Experience:

• Four (4) or more years’ experience in health insurance, Medicare Advantage, Accountable Care Organization, or other similar healthcare setting
• One (1) or more years demonstrated experience with Medicare Advantage Stars program experience.
• Experience with analytics and inferential statistics in a healthcare setting by monitoring and evaluate patterns, trends, to identify drivers of performance as it pertains to care, Quality, access, and affordability within defined member population. Developing and presenting insightful, actionable summaries and recommended actions.
• Advance Microsoft Excel skills (ability to create and build pivot tables, formulas,  etc.) and develop Excel-based models and spreadsheet containing advanced functions that are used to evaluate historical trends and forecasts to identify best practices.
• Experience coordinating and managing multiple projects and initiatives simultaneously.
• Excellent written and oral communication skills. 

Preferred Experience:

• Bachelor’s degree in business or health related field
• Project Management Certification
• Two (2) or more years demonstrated experience with Medicare Advantage CMS Stars program experience.
• Experience working with regulatory agencies and compliance environment with practical knowledge of Medicare Regulations

Other Requirements:

• Annual Flu Vaccine

KNOWLEDGE, SKILLS, AND ABILITIES

Required Competencies:

• Knowledge of applicable Medicare Star/ (NCQA)/CMS requirements
• Strong in the following competencies:
• Decision making/Judgment.
• Problem solving/Analysis and independently take action to address it.
• Communication
• Creativity/Innovation
• Ability to work independently.
• Strong knowledge of the CMS Star Rating System, including Healthcare Effectiveness Data and Information Set (HEDIS), Consumer        Assessment of Healthcare Providers and Systems (CAHPS), Health Outcomes Survey (HOS), Part D Events (PDE), and Administrative Measures
• Strong project management skills

PHYSICAL REQUIREMENTS

• Exerting up to 10 pounds of force occasionally (up to 1/3 of the time) and/or.
• A negligible amount of force frequently (1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body.
• Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time.
• Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

ABOUT HEALTHTEAM ADVANTAGE

HEALTHTEAM ADVANTAGE is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.