Sr. Medicare Program Analyst
About The Position
Privia Health is seeking a Senior ACO Performance Analytics Analyst to join its Medicare Value-Based Care Programs Analytics team. The role primarily supports Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP). It requires a combination of business and technical experience in value-based care analytics. The analyst tracks MSSP performance against established key performance indicators, communicates performance successes and issues, and provides actionable insights to support data-driven decisions and program success. The analyst works with CMS CCLF claims data, ACO and provider performance information, healthcare benchmarks, and risk adjustment scores. The role collaborates with IT, ACO leaders, and Operations teams and helps interpret value-based care policy and regulatory changes, particularly those related to MSSP. The salary range is $85,000 to $100,000 in base pay, exclusive of bonuses and benefits. The role is eligible for an annual bonus targeted at 15%. Base pay is determined by factors including experience, education, and geographic location. Benefits mentioned include 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.
Requirements
- At least 2 years of professional experience.
- Intermediate-level experience with SQL and SAS.
- Ability to communicate complex assessments and data-derived insights to varied audiences, including insights based on CMS guidelines, ACO performance indicators, and regional and national healthcare trends.
- Ability to distill analytical findings into clear insights and action steps.
- Ability to translate complex business problems into technical requirements and design solutions.
- Ability to remain flexible as priorities change.
- Strong relationship-building skills.
- Critical-thinking skills.
- Proactive and self-motivated.
Nice To Haves
- Bachelor’s degree preferred, 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 data, hospital admission and discharge data, healthcare codes (CPT/HCPCS, provider specialty, diagnosis, place of service, and revenue), healthcare claims adjudication (payments, adjustments or reversals, and denials), or healthcare claims processing.
- Snowflake experience.
Responsibilities
- Build and track KPIs for patient attribution, cost, utilization, risk stratification, and quality performance.
- Develop actionable analytics for participating Taxpayer Identification Numbers (TINs) and providers, highlighting actionable spending anomalies.
- Evaluate CMS HCC risk adjustment scores to identify performance gaps across the provider network.
- Build ad hoc models to compare an ACO’s 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 program policies and regulations, with emphasis on MSSP.
- Collaborate with IT, ACO leaders, and Operations teams to support Privia Health’s success in MSSP.
- Communicate performance wins and issues and provide actionable insights to ACOs.
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Life insurance
- Pet insurance
- 401(k)
- Paid time off
- Wellness programs
- Annual bonus targeted at 15%
- Expense reimbursement for employees who regularly work from home offices to offset internet costs
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
