Sr. Medicare Program Analyst
Core
Support Accountable Care Organizations (ACOs) in the MSSP program by tracking performance metrics, analyzing claims data, and providing actionable insights for data-driven decision-making.
Role type
Senior Medicare Program Analyst (Value-Based Care Analytics)
Builds
Actionable analytics for ACOs and providers, including spend anomaly detection and risk modeling
Domain
Healthcare / Value-Based Care (MSSP)
Deliverable
production ML models | dashboards & analysis
Required skills
Healthcare claims data analysis, SQL, SAS, HCC risk adjustment, CCLF data management, regulatory compliance, benchmark modeling
Preferred skills
Snowflake, EMR data, hospital admission/discharge data, healthcare coding (CPT/HCPCS), claims adjudication
Technologies
SQL, SAS, Snowflake
Responsibilities
Track patient attribution, cost, utilization, and quality performance; Build models to track expenditures against CMS benchmarks; Analyze CMS CCLF claims data for cost and utilization trends; Evaluate CMS HCC risk adjustment scores; Champion understanding of VBC policy and regulations
Seniority
Senior, hands-on IC
