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[Remote] Sr. Medicare Program Analyst

Remote · Australia Full-time

Note: The job is a remote job and is open to candidates in USA. Privia Health is seeking a senior analyst for its Medicare Value-Based Care Programs Analytics team. The role supports Accountable Care Organizations in the MSSP program by tracking performance, communicating wins and issues, and providing actionable insights for data-driven decisions.

Responsibilities

  • 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

Skills

  • 2+ years of professional experience
  • Intermediate level experience with SQL and SAS
  • 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
  • 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
  • Snowflake experience preferred

Benefits

  • Medical, dental, vision, life, and pet insurance
  • 401K
  • Paid time off
  • Other wellness programs
  • Annual bonus targeted at 10%
  • Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Company Overview

  • Privia Health is a physician enablement company that provides technology and services to optimize the healthcare delivery experience. It was founded in 2007, and is headquartered in Arlington, Virginia, USA, with a workforce of 501-1000 employees. Its website is http://www.priviahealth.com.
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