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 the
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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