Note: The job is a remote job and is open to candidates in USA. WellSky is a healthcare technology company that develops solutions for Home Health and Hospice providers and payers. The Data Analyst, Value-Based Insights role transforms Medicare claims data into metrics, benchmarks, and performance measures, while building SQL-based extracts, interpreting CMS methodologies, validating data, and collaborating with product and engineering teams.
Responsibilities
- Build and maintain claims-based data extracts and measures from CMS data sources, including the Chronic Conditions Warehouse (CCW) and Limited Data Set (LDS), to support VBI Home Health and Hospice solutions
- Develop and maintain performance measures such as HHVBP claims-based measures, MSPB-PAC, Functional Items, hospitalization/ER/PPH/DTC rates, utilization and efficiency metrics, length of stay, and composite/percentile scores
- Interpret CMS regulations and annual Final Rules (e.g., HHVBP methodology, eTPS calculations) and translate measure specifications into accurate, reproducible SQL logic
- Write and optimize SQL against large claims datasets in BigQuery; contribute to data pipelines, quarterly lookup-table refreshes, and extract automation
- Produce referral pattern, competitive analysis, market/benchmark extracts, and validate outputs against CMS public benchmarks (e.g., Home Health Compare) and client expectations
- Investigate data quality issues and metric discrepancies, and document methodology, data sources, and assumptions so results are auditable and repeatable
- Prepare data for downstream BI/visualization layers (e.g., Sisense) and collaborate with product managers and engineers to define technical requirements and analytical interpretations
- Perform other job duties as assigned
Skills
- Bachelor's degree in quantitative, health-informatics, or related field, or equivalent work experience
- 2–4 years of experience in data analysis, with demonstrated proficiency in SQL against large, complex datasets
- Direct experience working with Medicare/CMS claims data (e.g., CCW, LDS, LDS/RIF files, or comparable claims sources)
- Comfort with healthcare claims coding structures (e.g., ICD, HCPCS/CPT, revenue codes, DRGs)
- Ability to translate written specifications or methodologies into analytical logic and validate results for accuracy
- Willing to work additional or irregular hours as needed, particularly around quarterly CMS data refreshes and annual Final Rule cycles
- Must work in accordance with applicable security and HIPAA policies to safeguard company and client protected health information
- Must be able to sit and view a computer screen for extended periods of time
- Knowledge of Home Health and/or Hospice operations, post-acute care, or value-based care programs (e.g., HHVBP, HHVBP eTPS, hospice HIS/HOPE)
- Experience with CMS quality/value-based program methodologies and familiarity with reading CMS regulations/Final Rules
- Hands-on experience with BigQuery (or a comparable cloud data warehouse such as Snowflake) and a BI tool such as Sisense, Tableau, or Power BI
- Familiarity with risk adjustment or benchmarking concepts
- Scripting experience (e.g., Python) for data transformation and automation
Benefits
- Excellent medical with Rx, dental, and vision benefits
- Mental Health support through EAP
- Generous paid time off, plus 13 paid holidays
- 100% vested 401(K) retirement plans
- Educational assistance up to $2500 per year
Company Overview