Medicare Stars Reporting Analyst Principal (Job Number:11226)
Description
Summary:
This position is responsible for supporting the CMS Star program improvements through data analysis and development of small to moderate databases. Analyzes complex data and information to provide meaningful results, identifying success factors and improvement opportunities, suggesting potential solutions, and helping Government Programs Product Management set strategic directions. This position will also obtain data from internal and external sources, understand relevant differences between each data source, and design/create database structures for analysis and reporting. This position will support the identification and development of databases to support business functions for the Medicare products, using enrollment, medical and pharmacy claims information.
Accountabilities:
1. Participate in development and ongoing production of monthly predictive modeling tool for CMS Star ratings.
2. Develops and modifies databases of leading indicator data to model ever-changing CMS specifications. Investigates opportunities for expanded clinical data collection that are needed elements for HEDIS, CMS Stars, DHS Quality Initiatives.
3. Offer expertise and guidance on predictions, federal regulations, and health plan quality-improvement initiative effectiveness.
4. Performs complex analysis of the data. Researches, analyzes and interprets statistical data and provides technical assistance to other staff. Identifies issues to be researched, determining affected areas, estimating impact and leading the resolution.
5. Leads small team of multi-departmental peers in identification or implementation of process improvements to improve Star ratings. Independently manages the retrieval and analysis of data, and issues that may arise on multiple tasks or projects with limited management involvement.
6. Acts as a resource for other members of the department/division on business issues and may be responsible for training and guidance of other employees.
Qualifications
Required Qualifications:
1. Bachelor's degree in related field with 7 years healthcare or related job experience, or 11 years healthcare related experience in lieu of a degree.
2. Advanced (5+ years) experience building or maintaining databases (e.g., Access, SQL Server or similar platform )
3. Proficiency in Microsoft software applications such as Word, PowerPoint, Excel, Access.
4. Demonstrated ability to design, evaluate and interpret complex data sets.
5. Demonstrated ability to handle multiple tasks with competing priorities.
6. Demonstrated analytic and problem solving skills.
7. Excellent written and verbal communication skills and with an ability to interpret and communicate analytical information to both individuals and groups in a clear and concise manner.
8. Demonstrated ability to present complex technical information to non-technical audiences and to senior decision-makers. Demonstrated ability to work effectively both independently and in a team setting with individuals having diverse professional backgrounds including business, technical and/or clinical.
Preferred Qualifications:
1. Master’s degree in business, nursing, public health, health science, health economics, data systems, health promotion or related field.
2. Knowledge of health care performance measurement; CMS STAR ratings strongly preferred.
Physical description:
Is a sedentary position; requires extensive use of computer and telephone.
The job description is not intended to be an exhaustive list of all functions and responsibilities of the position. Employees are held accountable for all of the functions of the job. Job duties and the % of time identified for any function are subject to change at any time.
Blue Cross Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.
Primary Location: United States-Minnesota-Eagan
Shift: Day Job
Description
Summary:
This position is responsible for supporting the CMS Star program improvements through data analysis and development of small to moderate databases. Analyzes complex data and information to provide meaningful results, identifying success factors and improvement opportunities, suggesting potential solutions, and helping Government Programs Product Management set strategic directions. This position will also obtain data from internal and external sources, understand relevant differences between each data source, and design/create database structures for analysis and reporting. This position will support the identification and development of databases to support business functions for the Medicare products, using enrollment, medical and pharmacy claims information.
Accountabilities:
1. Participate in development and ongoing production of monthly predictive modeling tool for CMS Star ratings.
2. Develops and modifies databases of leading indicator data to model ever-changing CMS specifications. Investigates opportunities for expanded clinical data collection that are needed elements for HEDIS, CMS Stars, DHS Quality Initiatives.
3. Offer expertise and guidance on predictions, federal regulations, and health plan quality-improvement initiative effectiveness.
4. Performs complex analysis of the data. Researches, analyzes and interprets statistical data and provides technical assistance to other staff. Identifies issues to be researched, determining affected areas, estimating impact and leading the resolution.
5. Leads small team of multi-departmental peers in identification or implementation of process improvements to improve Star ratings. Independently manages the retrieval and analysis of data, and issues that may arise on multiple tasks or projects with limited management involvement.
6. Acts as a resource for other members of the department/division on business issues and may be responsible for training and guidance of other employees.
Qualifications
Required Qualifications:
1. Bachelor's degree in related field with 7 years healthcare or related job experience, or 11 years healthcare related experience in lieu of a degree.
2. Advanced (5+ years) experience building or maintaining databases (e.g., Access, SQL Server or similar platform )
3. Proficiency in Microsoft software applications such as Word, PowerPoint, Excel, Access.
4. Demonstrated ability to design, evaluate and interpret complex data sets.
5. Demonstrated ability to handle multiple tasks with competing priorities.
6. Demonstrated analytic and problem solving skills.
7. Excellent written and verbal communication skills and with an ability to interpret and communicate analytical information to both individuals and groups in a clear and concise manner.
8. Demonstrated ability to present complex technical information to non-technical audiences and to senior decision-makers. Demonstrated ability to work effectively both independently and in a team setting with individuals having diverse professional backgrounds including business, technical and/or clinical.
Preferred Qualifications:
1. Master’s degree in business, nursing, public health, health science, health economics, data systems, health promotion or related field.
2. Knowledge of health care performance measurement; CMS STAR ratings strongly preferred.
Physical description:
Is a sedentary position; requires extensive use of computer and telephone.
The job description is not intended to be an exhaustive list of all functions and responsibilities of the position. Employees are held accountable for all of the functions of the job. Job duties and the % of time identified for any function are subject to change at any time.
Blue Cross Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.
Primary Location: United States-Minnesota-Eagan
Shift: Day Job