Develop and maintain standardized Stars and Risk Adjustment reporting using internal data sources and CMS files within Databricks and Power BI, including writing and optimizing SQL and data transformation logic
Lead code development and end-user dashboard creation, applying subject-matter expertise to meet defined business needs including data modeling, reporting architecture, and visualization design
Serve as a subject matter expert on Risk Adjustment and Stars data sources, including MAO-004, 837, MMR, and MOR files, and ensure accurate interpretation and application of CMS guidance
Architect scalable reporting frameworks and data models that support long-term enterprise growth and automation
Present internal overviews and detailed analytical findings to stakeholders, including senior leadership, to ensure alignment and clarity on next steps
Analyze data to identify performance opportunities and develop actions plans to address gaps
Build a deep understanding of clinical workflows and collaborate cross-functionally to enhance documentation accuracy, gap closure strategies, and operational effectiveness
Partner with internal teams to share insights that may influence underwriting, contracting, forecasting, operations and other business areas
Support the growth of direct and matrixed team members by fostering knowledge‑sharing and sustainable progress toward departmental goals

Bachelor’s degree required; Master’s degree in healthcare or a related field, or actuarial certification (FSA/ASA in progress or completed) preferred
Minimum of five (5) years of progressive healthcare experience, including at least three (3) years focused on Medicare Advantage Stars and Risk Adjustment programs
Proficiency in SQL, R, and Python; experience working with large enterprise data warehouses; strong ability to build, modify and optimize data tables; intermediate-to-advanced Power BI skills, including complex DAX and data modeling
Ability to operate effectively in a matrixed environment and influence others to drive outcomes
Demonstrated experience building reporting and analytics infrastructure from the ground up
Extensive knowledge of CMS Risk Adjustment and Stars data files (MAO-004, 837, MMR, MOR)
Proven ability to independently conduct complex quantitative analyses and translate findings into strategic recommendations.

Comprehensive Benefits
Medical, dental, and vision insurance
Financial & Retirement Support – Competitive compensation, 401k with employer match, and financial wellness resources
Time Off & Leave – Paid holidays, flexible vacation time/PSSL, and paid parental leave
Wellness & Growth – Work life assistance resources, physical wellness perks, mental health support, employee referral program, and BenefitHub for employee discounts

Director, Medical Economics – Stars and Risk Adjustment

Key skills