[Hiring] Director of Medical Economics, Stars and Risk Adjustment @Monogram Health

Role Description

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.

• 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 action 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

Qualifications

• 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