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Medicare Revenue/STARS Lead

Primary Location: New York, NY
Additional Locations: CT-Hartford, NJ-Parsippany, NY-New York
**Qualified candidates will be in the NYC, Parsippany, NJ or Hartford, CT areas**

The Medicare Revenue/STARs Lead (NY/NJ) is responsible for directing the overall development, management and implementation of Aetna’s Medicare Stars and coding accuracy strategies for the NY/NJ market. The role is responsible for all aspects of driving collaborative decision-making and implementation of corporate, regional and local actions to maximize Medicare STARs/coding accuracy initiatives.
The Medicare Revenue/STARs Lead works closely with key business stakeholders to develop innovative ways to achieve performance goals across the NY and NJ markets. He/She develops, executes and manages strategies to work with providers and internal business partners to ensure the achievement of strategic Stars objectives and accurate coding. The Revenue/STARs Lead is accountable for health plan performance in these areas and is supported by Provider Collaboration Managers, Sr. Data Analyst and Quality Manager in achieving these objectives. The position reports to the Chief Medicare Officer for NY/NJ and is currently and individual contributor role with potential of developing a team that supports these activities.
Aetna Medicare is dedicated to providing the best in quality and value to Medicare beneficiaries. Optimizing business performance and Star Ratings is a foundational element of our mission. If you enjoy developing strategy and driving innovation around clinical healthcare delivery, provider engagement and payment, health plan service operations and member experience, please consider the Medicare Revenue/Stars Lead role.
Individuals applying should have a demonstrated, results-driven background, and enjoy working autonomously in data-driven, action-oriented environments. This highly visible role collaborates with corporate, regional and local health plan leaders on a daily basis.

Fundamental Components:
  • Develops, directs and manages STARs initiatives and works with provider groups to ensure accurate coding of health care conditions.
  • Identifies issues/gaps adversely impacting results and collaboratively implementing corrective action plans
  • Provides consultative support to corporate, regional, local resources around Stars program, measures, methodology and business impacts to drive strategy and actions
  • Optimizes regional Stars investment budget portfolio across plans to achieve target performance results
  • Works with corporate resources to manages the development and implementation of corporate performance improvement campaigns and initiatives as needed
  • Develops and delivers solutions that drive sustainable operating efficiency


Background Experience:
  • Medicare, Government Programs and Star Ratings.
  • Provider claim coding guideline
  • Cross-functional large scale initiatives with high degree of complexity.
  • Demonstrated experience successfully implementing change in regulated and highly complex organizations

This position is responsible for overseeing the Star Rating performance and provider coding accuracy in two markets (NY/NJ) accounting for over 400,000 members. It is critical that someone is dedicated to these initiatives on an ongoing basis and working directly with local market teams, contracted providers and corporate STARs and revenue resources to implement interventions so that the Stars bonus and rebates can be maximized. If not, degradation in Star Ratings and inaccurate coding can lead to loss in revenue and membership.

Additional Job Information:
Team leadership and team building skills.Analytical and planning skills.Negotiation/influencing skills.Relationship and change management skills.Organizational skills.Time management skills.Critical thinking skills.Oral and written communication skills.

Potential Telework Position:

Percent of Travel Required:
10 - 25%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position.

Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.


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