Sr. Medicare Program Analyst
普里维亚健康 TM 是一个技术驱动的，国家医生启用公司，与医疗团体，卫生计划和卫生系统合作，优化医生实践，改善患者体验，并奖励医生在面对人和虚拟环境中提供高价值护理。普利维亚平台由行业顶尖才华和卓越的医生领导者领导，并且包括可扩展的运营以及端到端，基于云计算的技术，可以降低不必要的医疗保健成本，实现更好的结果，提高患者的健康和供应商的福祉。我们正在寻找一名高级医师。亚科绩效分析师将加入我们的医疗保险基于价值的护理计划 (Medicare Value-Based Care Programs, VBC) 分析团队。角色主要重点是支持我们负责护理组织 (Acco) 在 MSSP 项目中。候选人必须具有混合体经验，在涉及 VBC 分析的业务和技术上都熟练了解。高级分析师将根据已建立的关键性能指标 (KPI) 密切跟踪 MSSP 方案中的表现，沟通绩效胜利和问题，并为 ACO 提供可操作的见解，使数据驱动决策能够导致 MSSP 成功。主要职责：·构建 &追踪关键绩效指标 (KPIs): 追踪患者归因，成本，利用率，风险分层和质量性能 · ACO&提供商绩效跟踪：为参与者建立可操作的分析数据 (TIN) 和供应商突出可操作性支出异常 · HCC 风险比分优化：评估 CMSHCC 风险调整比分以确定服务提供商网络中的业绩差距 ·基准与风险建模：构建专用模型来跟踪 ACO 实际支出与 CMS 确定的历史和区域基准相对 · CCLF 数据管理：分析 CMSCCF 数据要求监测整个护理成本，网络外泄漏和使用趋势 · 监管变化：支持基于价值的医疗保健 (VBC) 计划中的政策和法规理解 · 与 IT,ACO 领导者和运营团队合作以帮助确保 Priva Health 在 MSSP 项目中取得成功 · 2年以上专业经验 ·优先获得学士学位；卫生服务 （例如公共卫生）或量化专业 （如工程，分析，经济学，保险科学，统计）·医疗索赔数据，EMR,入院和退院数据，医疗保健公司
查看英文原文
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.
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
- 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 10%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
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 https://www.speedtest.net/. 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.