Sr. Medicare Program Analyst

Company Description

Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.

Job Description

We’re seeking a Sr. ACO Performance Analytics Analyst to join our Medicare Value-Based Care Programs(VBC) Analytics team. The role’s primary focus is to support our Accountable Care Organizations(ACOs) in the MSSP program. The candidate must have hybrid experience, knowledgeable in both business and technology involving VBC analytics. The Sr. Analyst will closely track performance in the MSSP program based on established Key Performance Indicators(KPIs), communicate performance wins and issues, and provide actionable insights to ACOs that enable data-driven decision making that leads to success in MSSP.

Primary Job Duties:

• 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

Qualifications

• 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), healthcare claims processing preferred
• Intermediate level experience with SQL and SAS
• Snowflake experience preferred

Interpersonal & Attributes:

• 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

The salary range for this role is $85,000 to $100,000 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 15%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Additional Information

All your information will be kept confidential according to EEO guidelines.

Technical Requirements (for remote workers only, not applicable for onsite/in office work):

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. We understand that healthcare is local and we are better when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.

Department: Medical Economics