Sr. Medicare Program Analyst

We’re seeking a Sr. ACO Performance Analytics Analyst to join our Medicare Value-Based Care Programs(VBC) Analytics team. The role’s primary focus is to support our Accountable Care Organizations(ACOs) in the MSSP program. The candidate must have hybrid experience, knowledgeable in both business and technology involving VBC analytics. The Sr. Analyst will closely track performance in the MSSP program based on established Key Performance Indicators(KPIs), communicate performance wins and issues, and provide actionable insights to ACOs that enable data-driven decision making that leads to success in MSSP.

Primary Job Duties:

• Build & Track Key Performance Metrics (KPIs): Track patient attribution, cost, utilization, risk stratification, and quality performance
• ACO & Provider Performance Tracking: Build actionable analytics for participating Taxpayer Identification Numbers (TINs) and providers that highlight actionable spend anomalies
• HCC Risk Score Optimization: Evaluate CMS HCC risk adjustment scores to identify performance gaps across the provider network
• Benchmark & Risk Modeling: Build ad-hoc models to track the ACO’s actual expenditures against CMS-established historical and regional benchmarks
• CCLF Data Management: Analyze CMS CCLF claims data to monitor total cost of care, out-of-network leakage, and utilization trends
• Regulatory Changes: Champion understanding of policy and regulations in Value Based Care (VBC) Programs with emphasis in the MSSP
• Collaborate with IT, ACO leaders, and Operations teams to help ensure Privia Health’s success in the MSSP program

• 2+ years of professional experience
• Bachelor’s Degree preferred; healthcare (e.g. public health) or quantitative major (e.g. engineering, analytics, economics, actuarial sciences, statistics)
• Experience in healthcare claims data, EMR, hospital admission and discharge data, healthcare codes (CPT/HCPCS/provider specialty, diagnosis, place of service, revenue), healthcare claims adjudication (claim payments, adjustment/reversals, denials), healthcare claims processing preferred
• Intermediate level experience with SQL and SAS
• Snowflake experience preferred

Interpersonal & Attributes:

• Ability to communicate complex assessments and insights derived from data, CMS guidelines, ACOs’ performance indicators, regional, and national healthcare trends to a variety of audiences
• Ability to distill analytical findings into clear insights and action steps
• Ability to translate complex business problems to technical requirements and design solutions
• Ability to remain flexible with changing priorities
• Relationship builder
• Critical thinker
• Proactive and self-motivated

The salary range for this role is $85,000 to $100,000 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 10%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.