Sr. Medicare Program Analyst

Privia Health•Remote, USA

5h•$85,000 - $100,000

About The Position

Privia Health is seeking a Sr. ACO Performance Analytics Analyst for its Medicare Value-Based Care Programs Analytics team. The role primarily supports Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP). The analyst combines business and technical knowledge of value-based care analytics to monitor performance against established key performance indicators, communicate successes and issues, and provide actionable insights that support data-driven decision-making. The analyst tracks patient attribution, cost, utilization, risk stratification, and quality performance; develops analytics for participating Taxpayer Identification Numbers and providers; evaluates CMS HCC risk adjustment scores; models ACO expenditures against CMS historical and regional benchmarks; and analyzes CMS CCLF claims data. The role also follows policy and regulatory changes in value-based care, particularly MSSP, and works with IT, ACO leaders, and Operations teams. The position offers a base salary range of $85,000 to $100,000, with an annual bonus targeted at 10%. The role also includes medical, dental, vision, life, and pet insurance, a 401(k), paid time off, and wellness programs. Employees who regularly work from home offices are eligible for expense reimbursement to offset internet costs. Remote workers must have internet speeds of at least 5 Mbps download and 3 Mbps upload before starting employment.

Requirements

At least 2 years of professional experience.
Intermediate-level experience with SQL and SAS.
Ability to communicate complex data assessments, insights, CMS guidelines, ACO performance indicators, and healthcare trends to varied audiences.
Ability to turn analytical findings into clear insights and action steps.
Ability to translate complex business problems into technical requirements and design solutions.
Ability to adapt to changing priorities.
Strong relationship-building skills.
Critical-thinking skills.
Proactive and self-motivated.

Nice To Haves

Bachelor’s degree preferred, particularly in healthcare (such as public health) or a quantitative field (such as engineering, analytics, economics, actuarial sciences, or statistics).
Experience with healthcare claims data, EMR, hospital admission and discharge data, and healthcare codes, including CPT/HCPCS, provider specialty, diagnosis, place of service, and revenue.
Experience with healthcare claims adjudication, including claim payments, adjustments or reversals, and denials.
Experience with healthcare claims processing.
Snowflake experience.

Responsibilities

Track KPIs for patient attribution, cost, utilization, risk stratification, and quality performance.
Develop actionable analytics for participating TINs and providers to highlight spend anomalies.
Evaluate CMS HCC risk adjustment scores to identify performance gaps across the provider network.
Build ad-hoc models comparing ACO actual expenditures with CMS-established historical and regional benchmarks.
Analyze CMS CCLF claims data to monitor total cost of care, out-of-network leakage, and utilization trends.
Promote understanding of value-based care policies and regulations, particularly those related to MSSP.
Collaborate with IT, ACO leaders, and Operations teams to support success in the MSSP program.
Communicate performance results and issues and provide actionable insights to ACOs.