Senior Medicare Program Analyst

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $85k - $100k / year

⏰ Full Time

🟠 Senior

📋 Program Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Privia Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

💳 Fintech

💰 $450M Post-IPO Equity on 2021-04

Healthcare • Fintech

Privia Health is a national physician platform transforming the healthcare delivery experience. They provide tailored solutions for physicians and providers, creating value and securing their future. Through high-performance physician groups, accountable care organizations, and population health management programs, Privia collaborates with health plans, health systems, and employers to better align reimbursements to quality and outcomes.

📋 Description

• Support Accountable Care Organizations (ACOs) in the MSSP program • Track performance in the MSSP program using established KPIs • Communicate performance wins and issues • Provide actionable insights to ACOs for data-driven decision-making • Track patient attribution, cost, utilization, risk stratification, and quality performance • Build actionable analytics for participating TINs and providers highlighting spend anomalies • Evaluate CMS HCC risk adjustment scores to identify provider-network performance gaps • Build ad-hoc models comparing actual ACO expenditures with CMS historical and regional benchmarks • Analyze CMS CCLF claims data to monitor total cost of care, out-of-network leakage, and utilization trends • Champion understanding of VBC policy and regulations, particularly MSSP • Collaborate with IT, ACO leaders, and Operations teams

🎯 Requirements

• 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) preferred • Intermediate level experience with SQL and SAS • Snowflake experience preferred • 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 • Critical thinker • Proactive and self-motivated • Minimum 5 MBPS download speed and 3 MBPS upload speed for remote work, acquired prior to employment • Ability to work remotely from the United States

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • Life insurance • Pet insurance • 401K • Paid time off • Wellness programs • Annual bonus targeted at 15% • Remote work • Expense reimbursement for employees who regularly work from home offices

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