Especialista en Preparacion Para las Estrellas Medicare
Regular
Exempt
GENERAL DESCRIPTION:
Responsible for supporting the Medicare Stars Program initiatives to improve scores for Consumer Assessment of Healthcare Providers and Systems (CAHPS), Health Outcomes Survey (HOS), and Healthcare Effectiveness Data and Information Set (HEDIS), among other Stars measures. Accountable for analyzing performance data, implementing initiatives, collaborating with cross-functional teams to drive performance improvements, facilitating stakeholder communication, and increasing employee and provider awareness of the Medicare Stars Program.
ESSENTIAL FUNCTIONS:
Support in the analysis and impact assessment of new Medicare measures and changes to the Stars Rating System.
Collaborate in the Strategies definition process to ensure the new Measure Readiness Plan.
Follow-up Operational areas Readiness Work Plan to ensure alignment with the expected period and execution. Maintain Readiness Work Plan documentation updated.
Support and Monitor CAHPS and HOS vendors to ensure compliance with contract key performance indicator (KPI), and Center for Medicare and Medicaid Services (CMS) regulations.
Analyzes data to identify trends, areas of interest, and opportunities for improvement.
Evaluating benchmarks against industry standards and competitors supports identifying best practices.
Supports the development of initiatives to improve Stars scores, collaborating with relevant departments to execute improvement plans.
Collaborates in developing internal communication materials to enhance understanding and engagement among employees regarding the department initiatives and goals. Ensure materials comply with CMS regulations, and internal policies and procedures.
In partnership with other departments, develop educational materials and programs for healthcare providers to enhance their understanding of Star measures.
Prepares and presents reports on status, implementation progress, and performance outcomes.
Monitors performance and maintains documentation of all activities, initiatives, and outcomes related to the assigned efforts. Keep the management informed about progress, challenges, and accomplishments.
Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
MINIMUM QUALIFICATIONS:
Education and Experience:
Bachelor's Degree in Business Administration, Health Services Administration, or other health-related
fields. At least one (1) year of experience reviewing and analyzing data, preferably in the Healthcare Insurance industry.
"Proven experience may be replaced by previously established requirements."
Certifications / Licenses:
N/A
Other:
N/A
Languages:
Spanish –
Advanced (comprehensive, writing and verbal)
English –
Intermediate (comprehensive, writing and verbal)
"Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento
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