Senior Medicare Program Analyst

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

📋 Description

• Assist Accountable Care Organizations (ACOs) involved in the MSSP program

• Monitor performance within the MSSP initiative utilizing established KPIs

• Communicate successes and challenges related to performance

• Offer actionable insights to ACOs for informed, data-driven decisions

• Track metrics such as patient attribution, cost, utilization, risk stratification, and quality performance

• Develop actionable analytics for participating TINs and providers to highlight spending anomalies

• Assess CMS HCC risk adjustment scores to identify gaps in provider-network performance

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

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

• Promote understanding of VBC policies and regulations, especially those related to MSSP

• Collaborate with IT teams, ACO leadership, and Operations

⛳️ Requirements

• Minimum of 2 years of professional experience

• Bachelor’s Degree preferred; ideally 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 coding (CPT/HCPCS, provider specialty, diagnosis, place of service, revenue), and claims adjudication (claim payments, adjustments/reversals, denials)

• Intermediate proficiency in SQL and SAS

• Experience with Snowflake is preferred

• Capability to convey complex assessments and insights from data, CMS guidelines, ACO performance metrics, and healthcare trends to diverse audiences

• Ability to distill analytical findings into straightforward insights and actionable steps

• Skill in translating intricate business challenges into technical specifications and designing solutions

• Adaptability to shifting priorities

• Strong critical thinking skills

• Self-motivated and proactive

• Minimum internet speed of 5 MBPS download and 3 MBPS upload for remote work, to be secured before employment

• Eligibility to work remotely from within the United States

🏝️ Benefits

• Medical insurance

• Dental insurance

• Vision insurance

• Life insurance

• Pet insurance

• 401K plan

• Paid time off

• Wellness programs

• Annual bonus aimed at 15%

• Opportunity for remote work

• Expense reimbursement for employees who consistently work from home offices