Value-Based Care Provider Performance Analyst

Viva Health•Birmingham, AL

About The Position

The Value-Based Care Provider Performance Analyst applies advanced analytical and technical skills to support the organization's value-based care initiatives, provider performance measurement, and fee-for-service contracting strategies. This role leverages diverse data sources to develop dashboards, financial models, and analytical outputs that drive performance improvement across value-based contracts, network adequacy, and reimbursement optimization. This individual collaborates with provider strategy leadership to identify insights, model contract scenarios, and communicate findings to internal and external stakeholders. This position supports analytics for corporate initiatives including value-based care program performance, provider incentive programs, Star/HEDIS quality measures, population health management, and FFS contracting analysis.

Requirements

Bachelor's Degree in Health Informatics, Business Analytics, Mathematics, Healthcare Management, Health Services Research, Public Health, or other related field
4+ years’ experience conducting data analytics using tools such as SQL, SAS, Tableau, or equivalent
Highly proficient in Microsoft Excel including complex formulas, conditional formatting, and Pivot Tables
Working knowledge of SQL, SAS, Crystal, or similar query and data manipulation tools
Proficient in Tableau and/or Power BI for dashboard development and data visualization
Experience working with healthcare claims and encounter data, including familiarity with ICD-10, CPT, and revenue code structures
Understanding of HIPAA data privacy and security requirements as they apply to member and provider analytics
Demonstrated ability to build and interpret financial models related to healthcare reimbursement, cost trends, or contract performance
Ability to manage multiple projects simultaneously within defined timelines with minimal supervision
Strong diagnostic and analytical skills to identify data quality issues, validate findings, and troubleshoot reporting problems
Experience presenting data-driven findings to leadership and stakeholders in clear, actionable formats
Ability to interpret technical specifications and apply them to business operations and analytic workflows
Strong oral, written, and interpersonal communication skills
High level of integrity and quality in all performed work
Valid driver's license in good standing

Nice To Haves

Master’s degree in a related field (MBA, MHA, MPH, or MS in Analytics)
Experience in managed care or health plan analytics, particularly value-based care, provider contracting. or Medicare Advantage
Experience with FFS reimbursement methodologies, rate modeling, and contract financial analysis
Experience with advanced statistical or actuarial methodologies
Knowledge of national healthcare quality metrics including CMS Star Ratings, HEDIS, Risk Adjustment, HCC coding, and medical coding (ICD-10, CPT, LOINC)
Familiarity with value-based care contract structures: shared savings, pay-for-performance, episode-based payments, and ACO/CIN frameworks
Knowledge of fee-for-service reimbursement methodologies including DRG-based, per diem, percent-of-charges, and APC structures
Experience in Medicare Advantage plan operations, HMO/PPO managed care environments, or health insurance analytics
Experience with predictive analytics, risk stratification modeling, or machine learning applications in a healthcare setting
Familiarity with social determinants of health (SDOH) data integration and health equity analytics
Knowledge of healthcare interoperability standards (HL7, FHIR, C-CDA) and experience working with EHR-sourced or claims-based data
Experience with R or Python for statistical analysis or advanced data manipulation
Capability to independently identify and evaluate performance improvement opportunities related to provider KPIs
Highly proficient in both Tableau and Power BI, with experience building executive-level interactive dashboards
Intermediate to advanced SQL proficiency; experience with data warehouse environments (Snowflake, Azure, Databricks)
Knowledge of data governance principles, data dictionary maintenance, and data quality management frameworks

Responsibilities

Design, develop. and maintain dashboards and performance reports that track value-based care program metrics including quality, utilization, cost, and risk-adjusted outcomes across Medicare Advantage and commercial lines of business.
Build and maintain financial models to support fee-for-service contract negotiations including rate analysis, trend modeling, case mix adjustments, stop-loss thresholds, and reimbursement scenario comparisons.
Analyze provider performance data against contract benchmarks and quality targets. Identify opportunities for improvement and present actionable findings to provider strategy leadership and external provider partners.
Support development of value-based contract structures including shared savings, pay-for-performance, and bundled payment arrangements through quantitative modeling and historical utilization analysis.
Monitor and report on Star Rating and HEDIS measure performance at the provider and network level. Integrate quality metrics into provider scorecards and incentive calculations.
Develop and apply predictive analytics and risk stratification models to identify high-risk member populations, support proactive care management, and prioritize provider-level interventions.
Incorporate social determinants of health (SDOH) data into population health analyses to inform health equity initiatives, network gap assessments. and targeted intervention strategies.
Execute data retrieval, transformation, and analysis using tools including SQL, SAS, Tableau, Power BI, Excel, and other data platforms to support provider contracting and population health analytics.
Ensure data integrity and accuracy across analytical outputs. Define and implement automated queries, reports, and validation checks to maintain consistency and scalability.
Maintain and document data sources, technical specifications, and analytical methodologies pertaining to value-based care and contracting analytics within the department data infrastructure.
Prepare presentation materials and written analyses for internal leadership and external provider meetings, translating complex data findings into clear, decision-ready insights.