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Director, Payer Analytics
Business Analytics

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Overview of the Role:

We are currently recruiting for a Director of Payer Analytics. This role is focused on leveraging data to understand opportunities and threats within the Medicare Advantage and Commercial plans Privia has risk arrangements. Select individual must be able to work in a fast-paced, ambiguous, high-growth environment and possess superior hands-on analytics, communication and consultative ability. (S)he must be able to address business questions and leverage healthcare payer data and knowledge of payer policy to produce analytics to drive operational value. Select individual will consult with both internal and external stakeholders to execute on value-add analytics.  

Primary Job Duties: 

  • Key analytics representative across the Medicare Advantage and Commercial landscape
  • ‘Quarterback’ analytics needs and work both independently and with analytics leadership team (and other key stakeholders) to coordinate and execute upon key deliverables
  • Cultivate deep knowledge of payer value-based deal structures and underlying key drivers
  • Champion deep understanding and thought leadership of deal dynamics predominantly in support of population health risk arrangements in Medicare Advantage/Commercial and future value based deals
  • Partner with Payer Contracting team and Population Health team to support analytics related to payer risk arrangements and population health operations
  • Manage MA/commercial data sources and building of datamarts for analytic data mining
  • Utilize data mining expertise to mine medical claims for insight into drivers of cost & utilization mediating contract performance
  • Model and understand quality and risk status/HCC coding efforts as a driver of contract achievement
  • Act as subject matter expert on technical aspects of various data sets, repositories and web portals with the ability to extract insights leveraging contemporary business analytics tools and techniques 

Minimum Qualifications:

The Director of Payer Analytics must have demonstrated payer and healthcare experience coupled with excellent “hands-on” data/claims mining skills. Exquisite communication, quantitative, technical and business problem solving skills, and the ability to exercise judgment and discretion with limited supervision. The successful candidate will possess the following competencies, knowledge, skills, abilities and personal attributes:

  • A high level of integrity, trust and ethics
  • Minimum Bachelor's Degree (advanced degree preferred) in Statistics, Finance, Mathematics, Engineering, Actuarial Sciences, Economics or related field required
  • Minimum of 8 years' experience working in a high functioning healthcare analytics/informatics team combined with experience in Health Plan / Medicare Advantage / Commercial payer analytics
  • Technical, analytical and financial experience in the subject area of healthcare claims and payer related data and constructs
  • Ability to conceptualize a business problem; translate into a data analytics inquiry; leverage contemporary analytical tools and techniques to formulate observations and recommendations; succinctly communicate to management
  • An orientation to action through logical and quick analysis of issues, seeking to understand the implications of decisions for customers, the business and its operations
  • A willingness to listen, succinctly debate and evaluate issues with an open mind to different opinions and approaches to problem solving
  • Effective negotiator or consensus builder, as is necessary
  • An individual who achieves results by consistently and vigorously holding oneself and others accountable for meeting goals and performance levels which are critical for the long-term health of the business
  • Deep knowledge of using business analytics in driving healthcare performance.
  • Advanced understanding of how to enable data and intelligence as a business partner
  • Deep experience with SAS, SQL, Excel and/or compatible data mining and business software

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

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