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
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