Director of Medical Economics

Job Summary

A company is looking for a Director of Medical Economics, Stars and Risk Adjustment.

Key Responsibilities

• Develop and maintain standardized Stars and Risk Adjustment reporting using internal data sources and CMS files
• Lead code development and end-user dashboard creation to meet business needs
• Analyze data to identify performance opportunities and develop action plans to address gaps

Required Qualifications

• Bachelor's degree required; Master's degree or actuarial certification preferred
• Minimum of five years of progressive healthcare experience, with three years focused on Medicare Advantage Stars and Risk Adjustment programs
• Proficiency in SQL, R, and Python; experience with large enterprise data warehouses
• Extensive knowledge of CMS Risk Adjustment and Stars data files
• Proven ability to conduct complex quantitative analyses and translate findings into strategic recommendations