Senior Medicare Program Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Assist Accountable Care Organizations participating in the Medicare Shared Savings Program (MSSP)

• Monitor patient attribution, costs, utilization, risk stratification, and quality performance key performance indicators (KPIs)

• Develop actionable analytics for involved Taxpayer Identification Numbers and providers, highlighting spending anomalies

• Assess CMS HCC risk adjustment scores to pinpoint performance gaps within the provider network

• Create ad-hoc models to compare actual ACO expenditures with CMS historical and regional benchmarks

• Analyze CMS CCLF claims data to track total cost of care, out-of-network leakage, and utilization trends

• Advocate for understanding of policy and regulatory changes in Value-Based Care programs, particularly MSSP

• Collaborate with IT, ACO leaders, and Operations teams to ensure success in the MSSP program

• Convey performance successes and challenges, providing actionable insights that facilitate data-driven decision-making

⛳️ Requirements

• A minimum of 2 years of professional experience

• Bachelor’s Degree is preferred in healthcare (e.g., public health) or a quantitative field (e.g., engineering, analytics, economics, actuarial sciences, statistics)

• Preferred experience with 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, adjustments/reversals, denials), and healthcare claims processing

• Intermediate experience with SQL and SAS is required

• Snowflake experience is preferred

• Ability to communicate complex assessments and data-driven insights to diverse audiences

• Capacity to distill analytical findings into clear insights and actionable steps

• Skill in translating complex business challenges into technical requirements and designing solutions

• Flexibility to adapt to changing priorities

• Technical requirements for remote work include a minimum download speed of 5 MBPS and an upload speed of 3 MBPS, to be acquired before employment

• Must be able to work remotely from within the United States

🏝️ Benefits

• Medical insurance

• Dental insurance

• Vision insurance

• Life insurance

• Pet insurance

• 401K

• Paid time off

• Wellness programs

• Annual bonus targeted at 10%

• Expense reimbursement for employees who regularly work from home offices