Hello Everyone! Hawaii's largest Healthcare Insurer is looking for a Business Data Analyst who has specific Healthcare experience. This person needs to have Medicare STARs experience as they will be working with Data in that realm. The ability to communicate with teams and pull data using SQL is needed. This person will sit fully remote but has to be flexible to work Hawaii hours. If you are interested in working on a large initiative in Hawaii to enhance their Medicare STARs Program, please apply below!
- Work with measure data sources and business owners to identify and analyze key drivers of performance and support improvement initiatives by providing data insights.
- Partner with other business areas to identify the best data sources for HEDIS, Administrative/Operations, Part D and CAHPS/HOS based Star measures. Apply understanding of standard quality measures (e.g., HEDIS, CAHPS, HOS) to identify additional strategic improvement levers (e.g., supplemental data, benefits alignment) that may impact quality outcomes.
- Extract data from electronic medical records, claims, Data Warehouse and other available sources. Apply data analysis methods to identify trends and root cause and make recommendations based on results.
- Translate data and into actionable information using tables, graphs, charts, written reports and presentations.
- Serve as Sightlines and Coreo subject matter expert for Stars team.
- Maintain the Star Ratings dashboard to ensure that it accurately tracks performance against program goals.
- Create and publish the Stars Dashboard and related metrics by the last business day of each month; supply actionable data to the Stars team and key operations areas to facilitate performance monitoring against targets, variance analysis, and year-end projections.
- Review CMS Advance Notice for proposed changes affecting current and upcoming Star rating periods. Notify Stars team and management of important proposed changes and the potential impact of the changes on their Star rating projection. Participate in BCBSA calls to discuss changes to Star Ratings measures and rating methodology. Provide their feedback to BCBSA on CMS’s proposed changes to Star measures and rating calculations.
- Review CMS Final Rate Announcement for changes in measures, methodology, and rating calculations that affect projection of their Star rating. Inform Stars team of changes that impact their Star rating. Recalculate current Star rating projections based on changes and notify senior management of updated projections. Advise appropriate areas of changes to measures and new measures so they can adjust their data collection and reporting process.
- Setup Stars Dashboard at the beginning of each year to incorporate all CMS changes to measures, rating methodologies, and cut points. Update glide paths, historical information, and calculations for each measure. Add new measures and remove old measures as outlined in the CMS Final Rate Announcement. Revise formulas for overall rating, domain summaries, Part C & D summaries, and r-factor calculations. Amend measure pages and summaries based on feedback from team and management. Revise Stars Dashboard measure-level target thresholds, glide paths, and historical performance upon publication of the updated Star Rating Technical Notes in September/October of each year.
- Evaluate new cut points for the upcoming Star year based on historical information for all Medicare contracts across the nation. Facilitate the annual target setting discussion with Stars team and get a consensus on cut points and targets for each Star measure for the upcoming year. Calculate overall target score to ensure our targets get us to desired Star score.
- Setup, update, and monitor Display measure dashboard each year. Alert team if there are significant changes in the performance of any of the Display measures.
- Download Acumen reports, prepare the monthly Patient Safety reports, and email out to stakeholders
- Review HPMS memos from CMS and disseminate relevant information to Stars team and stakeholders
- Manage and/or participate in various projects and cross-departmental teams that support the Stars program.
- Collaborate with other staff and management to complete assigned duties and objectives, facilitate communication, and resolve problems and issues quickly and positively.
- Serve as the performance data subject matter expert for the Stars team in various workgroups and efforts (e.g., data strategies, provider performance platforms such as Coreo, etc.). Write business requirements and test scripts, perform unit and system testing.
- Coordinate and support Stars improvement activities with the HCC risk adjustment organization to ensure integration and alignment of quality goals with HCC risk adjustment objectives.
- Participate in Blues plan and/or other industry work groups that support Star Rating improvement (e.g. FAST Network calls, surveys). Network with other plans across the nation to find out best practices for improving Star measures. Participate in FAST Network efforts to share their data and view data from other plans.
- Data analysis
- Business analysis
Looking forward to chatting with you more about the position!
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