STARS Program Manager

Company: Blue Cross and Blue Shield of Kansas
Location: Topeka
Posted on: May 14, 2022

Job Description:

The Stars Program Manager is, under the direction of the Manager Revenue Management, responsible for oversight of the Medicare Advantage (MA) Stars rating. This position will work jointly with Provider Relations, Finance, Medical Affairs, Compliance, and Information Technology and Service to monitor and ensure high MA Stars. This position will engage with and integrate multiple vendors into our operations to maximize MA Stars.

"This position is eligible to work remotely in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment."Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.Essential Functions

• Maintain subject matter expert knowledge of CMS and MA Stars program requirements and methodologies.
• Review CMS communications pertaining to Stars. Propose policy and procedure changes to comply with any new CMS requirements.
• Coordinate review of MA Stars results in accordance with internal and federal requirements to optimize revenue. Maintain reporting and modeling tools to achieve that end and identify and develop Stars improvement plans.
• Participate in the annual MA Health Effectiveness Data and Information Set (HEDIS) audit activities and other MA Stars reporting audits.
• Analyzes HEDIS data, including data audits, roadmap (data flow process) documentation, reports, statistical analysis, medical record extraction, and other HEDIS-related activities as needed.
• Lead/Assist with the development of provider education materials related to MA Stars.
• Present Stars initiatives and results to upper management.
• Expand knowledge of industry best practices and trends in MA Stars improvement initiatives.
• Analyze Stars performance for trend identification and to inform strategy development.
• Coordinate the development of MA Stars improvement initiatives & incentive programs, and lead their cross-divisional execution, through interpersonal influence and project management best practices.
• Support the identification, gathering, organizing, and analyzing of data sources, both internal and external, that improve our knowledge of enrollees and opportunities for enhanced Stars reporting. Propose alternative data sources and process improvements where possible.
• Track the outcomes from MA Stars improvement activities and support the enhancement of the models and strategy based on findings. Maintain the analysis and tracking models as needed and identify/develop model improvements.
• Prepares ad-hoc reports as needed.
• Coordinate MA Stars reviews and outcomes analysis with teammates and report results compared to Stars goals.QualificationsEducation
  • Bachelor's Degree in Mathematics, Statistics, Finance, Health Care or Business Administration, Management or related field is required.Experience
    • Proven experience within an MA Stars program is required. Multiple years' experience with MA Stars data analysis/reporting preferred.
    • Experience and knowledge in the healthcare delivery system, insurance finance, and the health industry is critical. Knowledge of compliance, information technology systems, and other health insurance concepts and principles is preferred.
    • Experience with and an understanding of data warehouse, data extraction tools, and analytics software and methods is preferred.Skills
      • Must possess advanced analytical, problem solving, and research skills.
      • Must have the ability to see and anticipate significant issues or trends affecting MA Stars.
      • Ability to accurately interpret CMS guidelines for the purpose of refining and implementing procedures that maintain high standards for the timely and accurate reporting of actionable information to relevant stakeholders.
      • Maintain current knowledge, skill and abilities in MA Stars theories, practices, and technologies.
      • Skilled with Microsoft Word, Excel, PowerPoint, and database management tools such as QMF for Workstation.
      • Ability to work with computer programming and PC data analysis tools.
      • Ability to understand the capabilities, limitations, and characteristics of the corporate data systems.
      • Ability to work with statistical software applications, such as R, SAS, or Minitab.
      • Must effectively use interpersonal and communications skills with tact and diplomacy. This position maintains interaction with vendors and employees throughout the company.Must have experience working on multiple ongoing projects and exhibit the capability to lead projects.
      • The ability to work well independently or with other employees, management, and vendor staff is expected.CompensationMin $89,523Mid $111,903Posting Close DateMay 30, 2022Pay Rate TypeSalary

Keywords: Blue Cross and Blue Shield of Kansas, Topeka , STARS Program Manager, Executive , Topeka, Kansas