Medicare Business Data Analyst

** Hybrid Work Environment - Must reside in Hawaii**

** Pay Range
: $68,000 - $133,000

Note
:
Individuals typically begin between the minimum to middle of the pay range

Serves as a Medicare business data analyst, leveraging data, performance metrics, and effective reporting to inform performance initiatives and strategy for Medicare Stars and Risk Adjustment team and cross-functional collaborating teams. Supports efforts with internal and external partners by providing relevant and actionable data. Works independently to support the team with data-driven performance management including: data management and synthesis of disparate sources, data analysis, reporting and data visualization.

Designs and develops data automation and streamlining that create workflow efficiencies by interfacing disparate IT systems through APIs, ETLs, or other technological solutions.

• Bachelor's degree in information systems, data analytics, mathematics or statistics and four (4) years of related work experience; or equivalent combination of education and related work experience.
• Demonstrated knowledge in identifying issues, collecting data, and analyzing and interpreting data.
• Knowledge of managed care/health care business processes, systems and applications for delivered services such as claims, encounters, provider data, and/or patient/member data.
• Intermediate working knowledge of Microsoft Office applications including Word, PowerPoint and Outlook.
• Advanced working knowledge of Microsoft Excel.
• Intermediate working knowledge of Micro Strategy, SQL, SAS, Access, R or other business intelligence language/tools.
• Intermediate working knowledge of Tableau or other data visualization tools.

• Report Development, Research and Analysis:
  • Develop and present reports that provide organizational awareness, insights and action plans to internal and external partners supporting Stars and Risk Adjustment performance improvement initiatives.
  • Integrates data and uses advanced analytical methods/tools to identify trends, issues, root causes and focused population segments, translating data into actionable visualizations using tables, graphs, charts, written reports and presentations.
  • Develops, implements and/or enhances methods to extract complex data sets from available sources (e.g., HMSA data repositories, HEDIS software, external party extracts, etc.).
  • Applies understanding of standard quality measures (e.g., HEDIS, CAHPS, HOS) to identify strategic improvement levers (e.g., supplemental data, benefit alignment) to impact Stars performance.
  • Applies understanding of Risk Adjustment Factor (RAF) and Hierarchial Care Conditions (HCC) to identify strategic improvement levers to improve Risk Adjustment
  • Ensures Stars measure data and Risk Adjustment data is complete and accurate by implementing effective controls and validation activities.
  • Work as part of an agile quality team supporting quality improvement initiatives, Medicare quality pilots programs and member incentive programs.
  • Ensure compliance to regulatory standards and requirements
• Stars and Risk Adjustment Performance Monitoring
  • Maintains a thorough understanding of the Medicare Part C & D Star Ratings Technical Notes, Risk Adjustment Factor (RAF) and Hierarchical Care Conditions (HCC). Monitor proposed changes, proactively identify potential risks to performance, as well as associated mitigation strategies.
  • Gathers data to create and publish Stars and Risk Adjustment dashboards and related metrics on a monthly basis. Proactively identifies and supports acquisition of new data sources.
  • Create and update reports for committees and other program-related teams, distributes actionable data to facilitate performance monitoring against current targets and year-end projections.
  • Works with internal and external teams to proactively identify and implement Stars and Risk Adjustement dashboard enhancements.
  • Validates CMS Stars plan performance reports (e.g., First Plan Preview, Westat MCAHPS reports) against internal data.
  • Suports ad hoc reporting requests for Stars and Risk Adjustment
• Data Automation and Streamlining
  • Reasearch, design and develop data automation between disparate data systems through interfacing, APIs, ETLs, or other technological solutions.
  • Work collaboratively as part of project teams to understand, research and document requirements for data, workflows, and business needs.
  • Works independently to progress assigned work according to timeline and deadlines, work…