Director Medical Economics, Stars and Risk Adjustment
Position: Director of Medical Economics, Stars and Risk Adjustment
The position of Director of Medical Economics, Stars and Risk Adjustment, will play a key role in advancing Monogram Health’s analytical capabilities and driving performance in Star Ratings and Risk Adjustment documentation accuracy. This role will serve as both the strategic leader and technical subject matter expert (SME) for Stars and Risk Adjustment analytics. The Director requires deep technical expertise, strong analytical rigor, and the ability to translate complex data into actionable strategy. The Director will partner with internal stakeholders to deliver standardized reporting, identify performance gaps, and support operational improvement initiatives.
Responsibilities
• 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
Position Requirements
• 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
Benefits
• Comprehensive Benefits - Medical, dental, and vision insurance, employee assistance program, employer-paid and voluntary life insurance, disability insurance, plus health and flexible spending accounts
• 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
About Monogram Health
Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders.
Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home.
Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum.
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The position of Director of Medical Economics, Stars and Risk Adjustment, will play a key role in advancing Monogram Health’s analytical capabilities and driving performance in Star Ratings and Risk Adjustment documentation accuracy. This role will serve as both the strategic leader and technical subject matter expert (SME) for Stars and Risk Adjustment analytics. The Director requires deep technical expertise, strong analytical rigor, and the ability to translate complex data into actionable strategy. The Director will partner with internal stakeholders to deliver standardized reporting, identify performance gaps, and support operational improvement initiatives.
Responsibilities
• 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
Position Requirements
• 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
Benefits
• Comprehensive Benefits - Medical, dental, and vision insurance, employee assistance program, employer-paid and voluntary life insurance, disability insurance, plus health and flexible spending accounts
• 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
About Monogram Health
Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders.
Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home.
Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum.
#LI-AS1
Apply tot his job
Apply To this Job