Job Description:
• Own the program’s analytics pipeline: intake and analysis of claims records, eligibility files, and MAO-004 reconciliation data across all clients.
• Own care-gap identification: the analysis that determines which validated findings represent open, addressable gaps.
• Own closure reconciliation on the program's vintage-cohort, MAO-004-evidenced measurement basis, including the monthly cohort measurement cycle and the collection-method distinctions (current eligibility vs. retrospective) that determine how cohorts are read.
• Own billing reconciliation: studies-analyzed and per-unit program activity reconciled to invoiced volume by client and by practice, at a standard that survives client audit.
• Build funnel instrumentation: stage-level conversion from finding identified, to shared with the physician, to acted on, to closed, so the program can see where value leaks rather than only its cumulative totals.
• Deliver practice-level performance analysis: which practices are converting, which need education or intervention, and where concentration or volume volatility creates program risk.
• Deliver the program’s baseline restatement on the vintage-cohort measurement basis and stand up the monthly measurement cycle aligned to CMS reconciliation windows in your first 90 days.
• Document, standardize, and progressively automate the pipeline in partnership with Product and Engineering, so the program’s measurement survives any individual.
Requirements:
• Deep hands-on fluency with healthcare claims data structures: professional and institutional claim formats, diagnosis and procedure coding, member and provider identifiers, and how eligibility files join to claims.
• Direct experience with healthcare regulatory and quality reporting: Medicare Advantage risk adjustment data, including MAO-004 files, strongly preferred; familiarity with CDI (clinical documentation integrity) reporting, encounter data, or similar plan-side reporting a strong plus.
• Demonstrated ability to build and run analysis independently, from SQL queries against large datasets through Excel and pivot-table analysis to finished output: these are working skills you use daily, not skills you manage in others.
• Rigor about correctness: your numbers appear on invoices and settle compensation and client performance conversations, and you treat that accordingly.
• Hypothesis-driven by habit: you ask the relevant questions, form a view, test it, verify the result, and repeat. We will ask what you built, what changed as a result, and what failed.
• Fluency with value-based care: risk arrangements, care-gap economics, and what closure means clinically and financially.
• Comfort operating without a large team: this is a builder-operator seat in a scaling program, with strong executive support and high visibility.
Benefits:
• Comprehensive medical plans - choose from three plans, including one with 100% of premiums covered for you and your dependents
• Vision & Dental
• Hybrid Time Off Policy (Flexible Time Off (FTO) Policy for exempt employees and Paid Time Off (PTO) Policy for non-exempt employees)
• Sick days in accordance with your state law
• 12 weeks of paid parental leave
• 12 Fixed Holidays (company closed)
• 5 Covera Days
• 401(k) Retirement Plan
• Annual Professional Development Stipend to invest in courses, books, or any other professional development related activity
• Annual Wellness stipend for fitness, mental health or other wellness expenses