Analyst, Medicare Value-Based Care Programs

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

The Medicare Program Analyst will work cross-functionally within the team, helping develop a  purpose-driven analytics platform to maximize our patient’s health and physicians' performance using proprietary applications. The primary emphasis for this role will be the analysis of Privia’s performance in the Shared Savings Programs (MSSP) and Medicare Primary Care Program in Maryland (MDPCP).

Primary Job Duties:

• Champion understanding of Medicare policy and regulations in Value-Based Care (VBC) Programs with an emphasis on the MSSP and MDPCP
  • Understand Medicare regulatory landscape related to Shared Savings programs, Accountable Care Organizations (ACO), and CMS’s new value-based initiatives
  • Develop subject matter expertise in existing programs, new guidelines, and regulations
  • Analyze the regulatory impact on Privia’s existing business, ACO and provider performance, patient attribution, risk stratification, patient cost of care, and utilization of healthcare services with an emphasis on Primary Care Services

• Work across functional teams to develop proprietary solutions to provide the business with the best analytics to drive success in existing contracts and evaluate new opportunities

• Analytics
  • Leverage claims, EMR, clinical, and third-party data 
  • Perform periodic and ad-hoc assessments to evaluate, track, and forecast ACO performance
  • Calculate Key Performance Metrics (KPIs) in patient attribution, cost, utilization, risk stratification, and quality performance

• Perform analysis to understand, track, and forecast provider performance
• Build scalable scheduled and ad-hoc reports for internal and external stakeholders

• Collaborate closely with IT leadership, engineers, and 3rd parties to build and enhance business analytics supporting Privia’s VBC business

Qualifications

• 1+ years of professional experience
• Bachelor’s Degree preferred; Preferably with healthcare (e.g., public health) or quantitative major (e.g., engineering, analytics, economics, actuarial sciences, statistics)
• Healthcare data savvy understands physician and inpatient 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 (data fields, content, formats, 830p, and 830i)
• Experience integrating, mapping, manipulating, and transforming data 
• Strong interest in developing experience with SQL and SAS

Interpersonal Skills & Attributes:

• Strong communication skills – the ability to communicate complex information or concepts clearly
• Creates clarity and adjusts style to the expertise of the audience
• Comfortable in a rapidly expanding evolving environment
• Highly collaborative and effective across an organization and multiple  stakeholders
• Ability to prioritize based on the needs of the organization
• Performance Driven – knows the team’s goals and how to prioritize personal and daily activities to meet those metrics
• Must comply with HIPAA rules and regulations

Colorado, New York, New Jersey, California and Washington Residents Only: The salary range for this role is $64,000 to $96,000 in base pay and exclusive of any bonuses or benefits. 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):

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