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Sr. Manager, APM Modeling & Analytics

3 weeks, 3 days ago
United States
Full-time
Lead
Data Scientist
Data Science and Analytics
Git Python SQL
Apply Now
Arcadia

Arcadia

Arcadia provides a healthcare data platform that enables organizations to unify diverse data sources, derive actionable insights through analytics, and enhance patient outcomes by delivering high-quality care experiences.

IT Services
251-1K
Founded 2002
$154M raised
View All Jobs 13

Description

  • Own end-to-end financial modeling for CMS LEAD and other alternative payment models.
  • Translate CMS technical specifications into production-grade actuarial models.
  • Develop and maintain benchmark, attribution, risk adjustment, and reconciliation logic.
  • Work directly with CMS VRDC data environments to extract, structure, and analyze Medicare claims and enrollment data.
  • Write production-level SAS and Python code to process claims data, support risk adjustment, and calculate and project PMPM benchmarks.
  • Run sensitivity testing, reconciliation, and true-up calculations, and ensure compliance with CMS methodological guidance.
  • Establish independent validation standards, automated testing scripts, exception reporting, and reconciliation frameworks.
  • Maintain version control, documentation, and auditability of all models to support audits or CMS review.
  • Serve as the internal subject matter expert for CMS APM financial modeling and support market communications on the CMS LEAD model.
  • Collaborate with actuaries and stakeholders to develop underwriting frameworks and improve existing APM solutions.

Requirements

  • Bachelor’s degree in Data Science, Actuarial Science, Finance, Economics, or a related field.
  • Minimum of 6 years of healthcare experience focused on CMS APMs, value-based contracting, and analytics.
  • Strong understanding of CMS and other value-based care models.
  • Experience working with CMS data sources such as VRDC, CCLF, and BCDA.
  • Strong coding skills in SAS, Python, and SQL.
  • Experience with database querying and BI tools such as Amazon QuickSight or equivalent.
  • Experience modeling and evaluating key financial parameters within value-based contracts for health plans or providers.
  • Actuarial experience, or experience supporting actuaries with CMS/CMMI models such as LEAD, TEAM, ACCESS, or MSSP, is preferred.
  • Consulting experience with deadline-driven project management and communication of technical topics to health plan or provider stakeholders is preferred.
  • Hands-on experience developing and overseeing product roadmaps related to VRDC assets is preferred.

Benefits

  • $160,000 to $180,000 annual salary.
  • Flexible, remote-friendly work environment.
  • Opportunity to lead high-profile client partnerships and influence actuarial strategy and product innovation.
  • Direct access to a large healthcare data asset for actuarial and analytics work.
  • Mission-driven culture with the agility of a tech company and the stability of a market leader.
  • Employee-driven programs and initiatives for personal and professional development.
  • Community membership through the Arcadian and Barkadian community.

Interested in this position?

Apply directly on the company website

Apply Now

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