Sr. Medicare Program Analyst

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.

The Sr. Medicare Program Analyst will work cross functionally within the team, helping develop a purpose-driven analytics platform to maximize the health of our patients and the performance of our physicians using proprietary applications. Primary emphasis for this role is tracking Privia Health’s performance in the Medicare Primary Care Program in Maryland (MDPCP).

Primary Job Duties:

• Champion understanding of Medicare policy and regulations in Value Based Care (VBC) Programs with emphasis in the MDPCP

• Develop subject matter expertise in MDPCP program, its guidelines, requirements, data and analytics

• Learn and understand the changes in guidelines, spearhead interpretation and application of the guidelines

• Assume leadership in educating the MDPCP team in regulatory changes, providing impact and opportunity analyses

• Analyze program and provider performance, patient attribution, risk stratification, patient cost of care, utilization of healthcare services with emphasis in Primary Care Services

• Work across functional teams to develop proprietary solutions to provide the business with the best analytics to drive success in MDPCP,  evaluate new opportunities, provide recommendations and impact analyses

• Leverage Medicare claims, EMR, clinical, third party data to perform periodic and ad-hoc assessments to evaluate, track, and forecast program performance

• Calculate Key Performance Metrics (KPIs) for patient attribution, cost, utilization, risk stratification, and quality performance

• Build standard and ad-hoc reports for internal and external stakeholders

• Collaborate closely with IT ,MDPCP program management, and Operations teams to help ensure Privia Health’s success in the MDPCP program

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• 2+ 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)

• Experience in 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) preferred

• Intermediate level experience with SQL and SAS required

• Snowflake experience preferred

Interpersonal Skills & Attributes:

• Strong communication skills - ability to communicate complex information or concepts clearly

• Creates clarity and adjusts style to expertise of audience

• Strong sense of leadership and accountability to assume ownership of program’s data and analytics responsibilities

• Comfortable in a rapidly expanding evolving environment

• Highly collaborative and effective across an organization and region amongst 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

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.

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. Privia is a better company 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.