Sr. Manager, APM Modeling & Analytics

Arcadia is dedicated to happier, healthier days for all. We believe that there is a better healthcare world – one powered by data. Our platform transforms complex, diverse data into a unified foundation for health, helping organizations deliver better care, boost revenue, and lower costs.

We’re a team of fiercely driven individuals committed to making healthcare more sustainable—and we’re looking for passionate people to help us get there.

For more information, visit arcadia.io  

Why This Role Is Important to Arcadia

Arcadia is expanding its leadership in advanced alternative payment models (APMs), including CMS’ newly announced LEAD Model and other value-based initiatives. This role will report directly to the Chief Actuary, and serve as the enterprise owner of APM solutions, ensuring technical rigor and financial accuracy across our most strategic engagements.

You will not simply advise on strategy — you will own the math.

This includes full accountability for:

CMS APM (e.g., LEAD, TEAM, ACCESS, MSSP) solution development and implementation CMS data (e.g., VRDC, CCLF, BCDA) ingestion and execution Independent validation and quality controls

This role requires deep understanding of CMS and other VBC models, expertise working with CMS data (e.g., VRDC, CCLF, BCDA), strong coding skills (e.g., SAS, Python, SQL), exceptional attention to detail in building and validating complex financial models at scale, and leadership in establishing and enforcing validation and quality assurance controls.

What Success Looks Like In 3 months

• Develop deep working knowledge of CMS LEAD model methodology and financial mechanics
• Contribute to Arcadia’s market communications on the CMS LEAD model (e.g., whitepaper, customer discussions)
• Gain hands-on access to VRDC data sources and Arcadia’s data ingestion processes
• Understand existing Arcadia APM calculation logic and identify improvement opportunities
• Establish coding standards and validation protocols for actuarial model governance

In 6 months

• Develop CMS LEAD model financial calculations and underwriting framework in collaboration with actuaries
• Fully own other existing Arcadia CMS APM solutions (e.g., MSSP)
• Serve as the internal subject matter expert for CMS APM financial modeling
• Build reproducible, well-documented SAS and Python pipelines for:
  • Customer data ingestion
  • Benchmark construction
  • Risk score development and normalization
  • Trend and PMPM projections
  • Savings/loss simulations
• Implement multi-layer QA processes and reconciliation procedures

In 12 months

• Deliver production-ready, validated CMS LEAD model outputs to clients
• Be recognized as Arcadia’s enterprise leader for APM financial modeling
• Establish formal governance for underwriting assumptions and change control
• Drive measurable financial accuracy and performance improvement across engagements
• Influence product roadmap to ensure actuarial precision is embedded in platform design

What You'll Be Doing

APM Model Ownership

• Own end-to-end financial modeling for CMS LEAD and other APMs
• Translate CMS technical specifications into production-grade actuarial models
• Develop and maintain benchmark, attribution, risk adjustment, and reconciliation logic
• Ensure integrity of actuarial inputs (e.g., underwriting methodology, pricing assumptions) in value-based contract modeling
• Identify model vulnerabilities and proactively mitigate financial exposure

CMS VRDC & Other Data Technical Execution

• Work directly with CMS VRDC data environments to extract, structure, and analyze Medicare claims and enrollment data
• Write production-level SAS and Python code to:
  • Process large claims datasets
  • Facilitate risk-adjustments
  • Calculate, risk adjust, and project PMPM benchmarks
  • Run sensitivity testing
  • Conduct reconciliation and true-up calculations
  • Ensure compliance with CMS methodological guidance
  • Validate data integrity prior to model production

  Quality & Validation Leadership

  • Establish independent validation standards and ensure consistent adherence to these standards across the enterprise
  • Create automated testing scripts and exception reporting to implement validation checks, parallel runs, and reconcil