Healthcare Data Specialist

Job Summary

We are seeking a highly skilled and knowledgeable MSSP (Medicare Shared Savings Program) Specialist to support our Value-Based Care (VBC) initiatives. The ideal candidate will have strong expertise in CMS programs, risk adjustment, quality reporting, and care coordination. This role will collaborate closely with clinical, operational, and analytical teams to ensure compliance, maximize program performance, and improve patient outcomes under MSSP and related value-based care models.

Key ResponsibilitiesMSSP & VBC Program Knowledge

• Understand and support various service lines within Value-Based Care (VBC).
• Demonstrate strong knowledge of CMS programs such as RPM (Remote Patient Monitoring), CCM (Chronic Care Management), and TCM (Transitional Care Management).
• Monitor and evaluate the implementation of these programs to ensure alignment with organizational goals.

Risk Adjustment

• Apply knowledge of HCC (Hierarchical Condition Category) risk scoring methodology.
• Collaborate with clinical and coding teams to ensure accurate documentation and coding that reflects patient risk profiles.
• Support strategies for risk score optimization while ensuring compliance with CMS regulations.

Quality & Compliance

• Interpret CMS quality measures, benchmarks, and reporting requirements.
• Track and monitor quality measures across patient populations and service lines.
• Assist with the preparation and submission of CMS quality reporting programs.
• Maintain compliance with CMS regulations, program updates, and audit requirements.

Cross-Functional Support

• Collaborate with care coordination teams to identify high-risk patients and implement effective interventions.
• Support clinical operations in driving improved patient outcomes and satisfaction.
• Partner with IT/data teams to ensure accurate integration and use of MSSP data sources.

Required Qualifications

• Bachelor’s degree in Computer Science, Public Health, Nursing, or a related field (Master’s preferred).
• 3+ years of experience in Value-Based Care, MSSP, ACO, or CMS-related programs.
• Strong understanding of CMS regulations, VBC service lines, and MSSP program requirements.
• Hands-on experience with CCLF data, HCC risk adjustment, and quality reporting.
• Knowledge of population health management tools, care coordination workflows, and performance improvement methodologies.
• Strong analytical skills with the ability to interpret complex datasets and provide actionable insights.
• Excellent communication and collaboration skills for working with clinical, operational, and executive stakeholders.

Preferred Skills

• Familiarity with EMR/EHR systems and healthcare data platforms.
• Experience with reporting and visualization tools (e.g., Power BI, Tableau, SQL).
• Strong project management and organizational skills.
• Ability to stay updated on evolving CMS regulations and guidelines.

Job Type: Full-time

Work Location: In person