Medicare Researcher (Remote Eligible)

Overview

This role involves designing and delivering real-world data analytics to support Medicare alternative payment models (APMs). Responsibilities include leading the development and deployment of statistical models and operational processes using administrative claims and other data sources, with a focus on pay-for-performance, episode-based bundled payment, and total-cost-of-care shared savings models.

Responsibilities

• Lead the development and deployment of statistical models and operational processes for APMs, including support for:
  • Payment incentive innovation
  • Development and testing improvements to existing payment methodologies
  • Construction of target prices
  • Reconciliation of provider fee-for-service payments against benchmarks
• Participate in oversight and execution of tasks related to:
  • Performance and payment calculations
  • Production of provider-specific data and performance reports
  • Analytics that inform program monitoring and decision-making
• Example project activities include:
  • Developing and implementing episode bundles
  • Testing alternative approaches to attribution, risk adjustment, and peer grouping
  • Calculating financial benchmarks and reconciliation payments
  • Assessing performance and refining performance scoring methods for model participants
  • Developing and producing provider feedback reports
  • Developing innovative approaches to monitoring compliance and conduct among APM participants
• Lead operational processes for APMs such as bundled payment, shared savings, or similar models, which may include:
  • Target price/benchmark determination
  • Payment reconciliation calculations
  • Technical assistance to providers
  • Analyses of model and provider performance
• Participate actively and thoughtfully in multidisciplinary teams using expertise in Medicare data and policy, health services research methodologies, and APM development, implementation, and analysis
• Author project reports, memos, technical assistance tools, issue briefs, and webinar presentations
• Contribute to the growth, expertise, and institutional knowledge of staff working in Medicare policy, APMs, and value-based care

Required Qualifications

• Master’s or doctoral degree or equivalent experience in data analytics, public health, public policy, economics, behavioral or social sciences, or other relevant disciplines.
• For Researcher-level candidates: over 5 years of experience working in health policy, health research, or real-world analytics, with a substantial portion dedicated to analyzing and supporting payer implementation of shared savings, bundled payment, or similar models.
• Experience reviewing and interpreting federal regulations and translating regulations into business requirements and technical specifications.
• Experience conducting analyses of Medicare Part A, Part B, Part D, enrollment, and other administrative data.
• Strong foundation in quantitative methods, including statistical techniques such as multivariate regression models, time series analysis, and imputation.
• Broad understanding of Medicare’s approach to value-based care and portfolio of APMs.
• Excellent written and oral communication skills, including the ability to explain observations and findings to diverse stakeholders (program administrators and policymakers).
• Demonstrated ability to coordinate multidisciplinary teams, be accountable for delivering ongoing activities, and work independently to solve complex problems.
• Strong organizational skills and high attention to detail; flexibility to lead and manage multiple priorities simultaneously under deadlines.

Preferred Qualifications

• None specified.

Compensation & Benefits

• Anticipated base salary: $100,000 - $135,000 annually.
• Competitive salaries and a comprehensive benefits package.
• 100% employee-owned structure with financial benefits of ESOP holdings.
• Eligibility for coworking spaces where available (for those not located near an office).

Additional Information

• Cover letter, resume, and writing sample must be submitted at the time of application.
• Background check is required.
• Various federal agencies with whom the employer contracts require staff to successfully undergo security clearance as a condition of working on the project; if assigned, the individual will be required to obtain the requisite security clearance.
• Equal Opportunity Employer.

Location

• Coworking spaces are available where offered for individuals not located near an office (option depends on area).