Value-Based Care Provider Performance Analyst

Value-Based Care Provider Performance Analyst

Location: Birmingham, AL

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Healthcare Reimbursement Account
• Paid Parental Leave
• Community Service Time Off
• Life Insurance and Disability Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals
• Employee Assistance Program

See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits

Job Description

The Value-Based Care Provider Performance Analyst applies advanced analytical and technical skills to support the organization's value-based care initiatives, provider performance measurement, and fee-for-service contracting strategies. This role leverages diverse data sources to develop dashboards, financial models, and analytical outputs that drive performance improvement across value-based contracts, network adequacy, and reimbursement optimization.

This individual collaborates with provider strategy leadership to identify insights, model contract scenarios, and communicate findings to internal and external stakeholders. This position supports analytics for corporate initiatives including value-based care program performance, provider incentive programs, Star/HEDIS quality measures, population health management, and FFS contracting analysis.

Key Responsibilities

• Design, develop. and maintain dashboards and performance reports that track value-based care program metrics including quality, utilization, cost, and risk-adjusted outcomes across Medicare Advantage and commercial lines of business.
• Build and maintain financial models to support fee-for-service contract negotiations including rate analysis, trend modeling, case mix adjustments, stop-loss thresholds, and reimbursement scenario comparisons.
• Analyze provider performance data against contract benchmarks and quality targets. Identify opportunities for improvement and present actionable findings to provider strategy leadership and external provider partners.
• Support development of value-based contract structures including shared savings, pay-for-performance, and bundled payment arrangements through quantitative modeling and historical utilization analysis.
• Monitor and report on Star Rating and HEDIS measure performance at the provider and network level. Integrate quality metrics into provider scorecards and incentive calculations.
• Develop and apply predictive analytics and risk stratification models to identify high-risk member populations, support proactive care management, and prioritize provider-level interventions.
• Incorporate social determinants of health (SDOH) data into population health analyses to inform health equity initiatives, network gap assessments. and targeted intervention strategies.
• Execute data retrieval, transformation, and analysis using tools including SQL, SAS, Tableau, Power BI, Excel, and other data platforms to support provider contracting and population health analytics.
• Ensure data integrity and accuracy across analytical outputs. Define and implement automated queries, reports, and validation checks to maintain consistency and scalability.
• Maintain and document data sources, technical specifications, and analytical methodologies pertaining to value-based care and contracting analytics within the department data infrastructure.
• Prepare presentation materials and written analyses for internal leadership and external provider meetings, translating complex data findings into clear, decision-ready insights.

REQUIRED:

• Bachelor's Degree in Health Informatics, Business Analytics, Mathematics, Healthcare Management, Health Services Research, Public Health, or other related field
• 4+ years’ experience conducting data analytics using tools such as SQL, SAS, Tableau, or equivalent
• Highly proficient in Microsoft Excel including complex formulas, conditional formatting, and Pivot Tables
• Working knowledge of SQL, SAS, Crystal, or similar query and data manipulation tools
• Proficient in Tableau and/or Power BI for dashboard development and data visualization
• Experience working with healthcare claims and encounter data, including familiarity with ICD-10, CPT, and revenue code structures
• Understanding of HIPAA data privacy and security requirements as they apply to member and provider analytics
• Demonstrated ability to build and interpret financial models related to healthcare reimbursement, cost trends, or contract performance
• Ability to manage multiple projects simultaneously within defined timelines with minimal supervision
• Strong diagnostic and analytical skills to identify data quality issues, validate findings, and troubleshoot reporting problems
• Experience presenting data-driven findings to leadership and stakeholders in clear, actionable formats
• Ability to interpret technical specifications and apply them to business operations and analytic workflows
• Strong oral, written, and interpersonal communication skills
• High level of integrity and quality in all performed work
• Valid driver's license in good standing

PREFERRED:

• Master’s degree in a related field (MBA, MHA, MPH, or MS in Analytics)
• Experience in managed care or health plan analytics, particularly value-based care, provider contracting. or Medicare Advantage
• Experience with FFS reimbursement methodologies, rate modeling, and contract financial analysis
• Experience with advanced statistical or actuarial methodologies
• Knowledge of national healthcare quality metrics including CMS Star Ratings, HEDIS, Risk Adjustment, HCC coding, and medical coding (ICD-10, CPT, LOINC)
• Familiarity with value-based care contract structures: shared savings, pay-for-performance, episode-based payments, and ACO/CIN frameworks
• Knowledge of fee-for-service reimbursement methodologies including DRG-based, per diem, percent-of-charges, and APC structures
• Experience in Medicare Advantage plan operations, HMO/PPO managed care environments, or health insurance analytics
• Experience with predictive analytics, risk stratification modeling, or machine learning applications in a healthcare setting
• Familiarity with social determinants of health (SDOH) data integration and health equity analytics
• Knowledge of healthcare interoperability standards (HL7, FHIR, C-CDA) and experience working with EHR-sourced or claims-based data
• Experience with R or Python for statistical analysis or advanced data manipulation
• Capability to independently identify and evaluate performance improvement opportunities related to provider KPIs
• Highly proficient in both Tableau and Power BI, with experience building executive-level interactive dashboards
• Intermediate to advanced SQL proficiency; experience with data warehouse environments (Snowflake, Azure, Databricks)
• Knowledge of data governance principles, data dictionary maintenance, and data quality management frameworks