Centers for Medicare-Medicaid Services Value-Based Payment Lead - New York, NY

MetroPlusHealth; New York (NY); Hybrid; USD 90,000 - 130,000; Full time

Job summary

MetroPlusHealth in New York, NY, seeks a CMS VBP Lead to build and evolve financial analytics for CMS products. The role focuses on data extraction, transformation, and interpretation to inform internal and external reporting and cross-department knowledge sharing.

The ideal candidate has a Bachelor’s degree with at least 3 years in healthcare analytics, strong Excel/SQL skills, and dashboard experience with Tableau or PowerBI. Hybrid work model and cross-functional collaboration are expected.

Qualifications

• Bachelor’s degree required with at least 3 years in a related field (healthcare, business, or consulting).
• Proficiency in Excel and SQL is necessary for data work and reporting.
• Experience creating dashboards with Tableau, PowerBI, or Excel is desirable.

Responsibilities

• Produce accurate, insightful, and actionable reporting for CMS products and stakeholders.
• Stay updated on CMS value-based contracting models and relate them to network opportunities.
• Develop and maintain ETL processes from diverse data sources (flat-files, APIs, actuarial data).
• Create dashboards and ad-hoc reports to assess CMS Star ratings and provider performance.
• Collaborate with actuaries and staff on Medicare bid submissions and VBP impact analyses.
• Query large datasets (claims, membership, roster) to deliver ad-hoc insights.

Skills

Data analysis

Presentation skills

Education

Bachelor's Degree

Tools

SQL

Microsoft Excel

Tableau

PowerBI

Job description

Position Overview

The purpose of CMS VBP Lead position to MetroPlusHealth is to build out, maintain and evolve, according to theplan’s need, the core of financial analytics and reporting for our CMS products. This position is responsible for research, implementation, and interpretation of data and reporting for these products with the intent of using thisinformation for company-wide communications, external stakeholder reporting and intradepartmental communications to build up the knowledge for others to effectively use this data.

Scope of Role & Responsibilities

• Produce accurate, insightful, and actionable reporting for our CMS products for executive, external and peer stakeholders.
• Stay up to date on the various CMS approved value-based contracting models and correlate them to potential opportunities within our network.
• Develop and maintain extraction, transformation and load (ETL) processes stemming from various data sources such as flat-files, APIs and actuarial data.
• Build and share knowledge of the various data assets applicable to our CMS products and the appropriate use cases.
• Provide scheduled regulatory and ad-hoc reporting related to Medicare to CMS and internal stakeholders.
• Work with actuaries and internal staff on Medicare bid submissions as it pertains to the impact of implementing value-based arrangements within that product.
• Query large sets of data including claims, membership and roster information to deliver ad-hoc reporting as necessary.
• Collaborate with our quality department on the identification of outliers impacting our CMS Star ratings.
• Prepare dashboard and ad-hoc reports for the assessment of a contracted provider entity’s performance as it pertains to value-based opportunities and CMS Star impact/performance.
• Identify and communicate areas of opportunity as it pertains to our data, network performance or financials.
• Work with staff to prepare analyses on various aspects of financial risk arrangements including valuebased payment (VBP) arrangements, revenues, expenses, utilization, quality, and membership over time.
• Collaborate with internal staff on programming, knowledge sharing, and best practices.
• Act as a liaison with provider finance and operations staff.
• Special projects and other related duties as assigned

Required Education, Training & Professional Experience

• Bachelor’s Degree required with minimum of 3 years of experience industry related (business, health care, consulting, insurance, government)
• Insurance operations experience specific to Medicare and CMS Stars performance is preferred.
• Proficiency in Microsoft Excel and SQL are necessary.
• Experience with creating dashboards (Tableau, PowerBI, & Excel) is desired.
• Ability to present data, findings and ideas to leadership is desired.
• Experience in developing data pipelines is desired.
• Experience with statistical systems and data reporting.

Professional Competencies

• Customer Focus
• Functional/Technical skills
• Excellent verbal, written and mathematical skills

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