The Data Analyst for Value-Based Insights (VBI) is responsible for transforming Medicare (CMS) claims data into metrics, benchmarks, and measures that power WellSky's VBI product for Home Health and Hospice providers and payers. This role builds and maintains claims-based data extracts and performance measures, translates CMS methodologies and regulatory rules into production analytics, and partners with product and engineering to deliver trusted, data-driven insights. The work is retrospective, methodology-driven, and directly tied to how agencies measure and improve value-based performance.
Key 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.
Required Qualifications:
- 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.
Preferred Qualifications:
- 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.
Job Expectations:
- 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.
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Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky:
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