Sr. ACO Analyst

Cape Cod Healthcare Inc; Hyannis (MA); On-site; USD 63,000 - 105,000; Full time

Job summary

Cape Cod Healthcare is seeking a Sr. ACO Analyst to develop metrics and reports for PHO/CCHN initiatives and value-based contracts.

You will work with EMR data, perform risk stratification, and support provider-level analyses to improve population health and contract performance. The role requires a BA/BS, 5+ years in healthcare informatics or analytics, strong SQL and Excel skills, familiarity with ICD-10/CPT codes, and experience with data visualization tools.

Qualifications

• Bachelor’s degree or equivalent combination of education and experience.
• 5 years of experience in healthcare informatics or analytics.
• Knowledge of ICD-10, DRG, CPT, HCPCS, revenue codes.
• Knowledge of SQL, reporting systems, relational databases and healthcare IT systems.
• Advanced Microsoft Excel experience.
• Ability to learn new information systems and data sets.
• Ability to prioritize multiple demands and present concepts clearly.
• Epic experience (preferred).
• CMS Medicare Shared Savings Program knowledge (preferred).
• Experience with CMS claim and claim lines (CCLF) (preferred).
• Experience with Power BI (preferred).
• Experience with Microsoft Fabric, Python, JavaScript, HL7 FHIR, USCDI (preferred).

Responsibilities

• Develops and maintains data sets for advanced reporting on PHO value-based care performance.
• Supports PHO case management and provider-level reports.
• Maintains dashboards and supporting documentation.
• Identifies trends in claims or EMR data and performs risk stratification.
• Extracts, transforms and loads data via flat files or APIs.
• Utilizes Epic and other EMRs to extract relevant analyses and validate data.
• Supports data exchange with payers for contract performance.
• Assists leadership with analyses of contract proposals and fee schedules.
• Implements data governance to document sources and methods.
• Analyzes population health trends and high-risk groups to improve care.
• Develops credible metrics and benchmarks to measure PHO performance.
• Delivers high-quality service to patients and staff.
• Suggests process improvements and supports continuous improvement culture.

Skills

Healthcare analytics

SQL proficiency

Advanced Excel

Communication

Independent/team work

Education

Bachelor's degree

Tools

SQL

Excel

Power BI

Epic

CMS data feeds (CCLF)

Microsoft Fabric

Python

JavaScript

HL7 FHIR

USCDI

Job description

Job Description - Sr. ACO Analyst (260821-50004772)

Job Description

Sr. ACO Analyst - ( 260821-50004772 )

Purpose of Position

Develops metrics and reports in support of the Physician-Hospital Organization(“PHO”), also known as Cape Cod Healthcare Network(“CCHN”), to participate and perform well in value-based commercial contracts, Medicaid accountable care programs and the Medicare Shared Savings Program.

Description

• 1. Develops and maintains data sets to enable advanced reporting on several aspects of value-based care performance related to PHO covered lives, including cost and utilization, quality, and ambulatory care management.
• 2. Supports PHO case management, quality and risk coding teams with performance reports and actionable insights, including provider-level reports.
• 3. Maintains department operational and performance dashboards and related supporting documentation.
• 4. Identifies and reports on trends or patterns within administrative claims or EMR data sets; performs risk stratification analysis identifying illness burden and high-risk patients.
• 5. Extracts, transforms and loads administrative claims and electronic medical record(“EMR”) data via flat file or query via application programming interface(“API”)
• 6. Utilizes Cape Cod Healthcare(“CCHC”) Epic and other EMRs (e.g., Athena, eClinicalWorks) to extract information relevant to analyses and validate EMR data findings.
• 7. Supports clinical data exchange with payers and in support of contract performance or maintenance of the provider network.
• 8. Assist PHO and CCHC leadership with development of analyses of contract proposals, fee schedules, charge-master changes and contract performance.
• 9. Utilizes good data governance standards when bringing together differing data sets by documenting assumptions, sources, methods and validating control totals.
• 10. In coordination with PHO staff, analyze data to view population health trends and patterns; identify individual health risks and high-risk populations; find opportunities to improve care at the population and individual level.
• 11. In coordination with PHO staff, develops credible metrics and internal/external benchmarks in order to measure PHO performance against “goal.”
• 12. Consistently provides service excellence to all patients, family members, visitors, volunteers, and co-workers.
• 13. Challenges current working practices, identifies process improvement opportunities, and presents recommendations and solutions to management. Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.

Qualifications

• Minimum of Bachelor’s degree or equivalent combination of education and experience to meet the needs of the position.
• 5 years of experience in healthcare informatics, managed care analytics or a related healthcare field.
• Knowledge of industry standard coding, such as ICD-10, DRG, CPT, HCPCS, and revenue codes.
• Knowledge of and experience with SQL, reporting systems, relational databases and healthcare information systems required.
• Advanced Microsoft Excel experience required.
• Ability to learn and master new information systems and data sets.
• Ability to effectively prioritize multiple demands and quickly absorb new ideas and concepts.
• Ability to present concepts and analytical results logically and concisely.
• Ability to work both independently and as part of a team.
• Confidentially maintain information in accordance with policy.
• (Preferred) Epic experience
• (Preferred) Experience with CMS Medicare Shared Savings Program structure, operations, requirements and reporting
• (Preferred) Experience with CMS claim and claim line feed files (CCLF).
• (Preferred) Experience with data visualization software such as Power BI..
• (Preferred) Experience with Microsoft Fabric, Python, JavaScript, HL7 FHIR and USCDI.

Primary Location

Massachusetts-Hyannis

Department : HCI-PO - PHO

Annual/Hourly : Annual - Based on Full Time Employment

Hiring Pay Range : $ 81100 - $ 105000

Thepayrange displayed on each job posting reflects the anticipated range for new hires. A successful candidate’s actual compensation will be determined after taking factors into consideration such as the candidate’s work history, experience, skill set, and education. This is not inclusive of the value of Cape Cod Healthcare’s benefits package (if applicable), which includes among other benefits, healthcare/dental/vision and retirement. For annual salaries this is based on full-time employment.

Beware scam interview requests

Cape Cod Healthcare has been made aware of an instance in which a potential scammer has attempted to impersonate CCHC leadership and request chat interviews. Please note this is not our process and we will never direct you to interview solely through web-based chat. For any questions about available job opportunities or to learn more about our interview process please visit our careers page: https://www.capecodhealth.org/careers/