Risk Adjustment, Financial Analyst (Hybrid NY)

Healthfirst; New York (NY); Hybrid; USD 69,000 - 100,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Incentive programs

Life insurance

401k contributions

Job summary

Healthfirst is seeking a financial analyst to evaluate the performance of its products and model provider reimbursement changes. You will gather data, perform ad hoc analyses, and present results to management, supporting cost-reduction initiatives and ROI studies for vendors.

The role requires strong modeling skills, advanced Excel, and proficiency in SQL/Python/SAS or R, with experience in Redshift/S3 and data warehousing. Prior experience in health insurance analytics is preferred.

Qualifications

• Bachelor's degree or higher in Finance, Accounting, Business, Healthcare Administration, or related field.
• Experience in modeling financial impact.
• Self-motivated, creative problem solver who can work independently and collaborate through strong communication.
• Strong time management to handle multiple projects in a fast-paced environment.
• Knowledge of statistical methodologies and tools, including experimentation design.
• Demonstrated success analyzing large datasets.
• Excel – Advanced.
• Proficient in SQL, Python, SAS or R.
• Proficiency with Redshift and S3 or similar cloud data warehouse solutions.
• Familiarity with data models and/or data modelling.
• Experience with Alteryx, Tableau, Amazon Redshift, QlikView, or other similar tools/platforms.

Responsibilities

• Analyze the financial performance of Healthfirst products, identify trends, and develop recommendations for management.
• Create financial models to evaluate provider reimbursement changes.
• Gather data and conduct ad hoc analyses and present analytical reports.
• Support department projects related to medical cost reduction initiatives.
• Assist with RoI analyses for vendors to assess performance.
• Track NY Medicaid and Medicare reforms and their impact on Healthfirst and owner hospitals.
• Create/modify/update analysis for Provider Organizations.
• Contract analysis and fee schedule modeling.
• Maintain project logs and work plans.

Skills

Excel Advanced

SQL

Python

SAS or R

Redshift/S3

Alteryx

Tableau

QlikView

Data modelling

Education

Bachelor's degree in Finance/Accounting/Business/Healthcare Admin

Tools

Redshift

S3

Alteryx

Tableau

QlikView

AWS data warehouse

Job description

Job Duties/Responsibilities:

• Analyze the financial performance of all Healthfirst products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to management.
• Create financial models to evaluate the impact of provider reimbursement changes.
• Gather data and conduct ad hoc analyses as directed by other department team members and assist with the development and presentation of analytical data reports.
• Support department projects related to medical cost reduction initiatives.
• Assist with Return on Investment (RoI) analyses for vendors to determine if their financial and clinical performance is achieving desired results.
• Keep abreast of New York Medicaid and Medicare reforms and their impact on Healthfirst and their owner hospital performance.
• Responsible for creating, modifying, and updating analysis for Provider Organizations.
• Responsible for contract analysis and fee schedule modeling.
• Maintain current project logs and work plans on assignments.
• Additional duties as assigned.

Minimum Requirements:

• Bachelor's degree or higher from an accredited institution with a concentration in Finance, Accounting, Business, Healthcare Administration, or related field.
• Experience in modeling financial impact.
• Self-motivated, creative problem solver who can work independently and collaborate through strong communication and interpersonal skills.
• Strong time management experience and ability to handle multiple projects in a fast-paced environment.
• Knowledge of statistical methodologies and tools, including experimentation design.
• Demonstrated success analyzing large datasets.
• Excel – Advanced.
• Proficient in SQL, Python, SAS or R.
• Proficiency with Redshift and S3 or similar cloud data warehouse solutions.
• Familiarity with data models and/or data modelling.
• Experience with Alteryx, Tableau, Amazon Redshift, QlikView, or other similar tools/platforms.

Preferred Requirements:

• Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other payment mechanisms.
• Experience with analyzing medical cost and utilization trends.
• Current or previous work experience with a Health insurance company.
• Knowledge of Medicaid and Medicare programs.
• Provide support to the department’s performance improvement work groups.
• Monitor costs and revenue trends and assist in understanding trends.
• Understand and analyze impacts of new program changes.
• Utilize statistical tools to identify, analyze, and interpret patterns and trends in complex data sets.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [e-mail] or calling 212-519-1798. In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied.

Thank you for considering a career with HF Management Services, LLC.

Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $68,900 - $99,620

All Other Locations (within approved locations): $61,300 - $91,120

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

• medical, dental and vision coverage
• incentive and recognition programs
• life insurance
• 401k contributions

Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

Healthfirst is New York’s largest not-for‑profit health insurer offering it’s nearly 1.7 million members access to high-quality, affordable healthcare. As part of the community for nearly 30 years, Healthfirst’s unique advantage is rooted in its belief that good health doesn’t start in a doctor’s office. The company’s mission is to put its members first by working closely with care providers and community leaders to address broader issues that can impact health and well-being. This value-based care model is the foundation of the company’s sustained growth in one of the most dynamic markets in the country. So, if you are passionate about what you do and want to work for a company that is focused on the future and dedicated to making a difference in people’s lives, then Healthfirst is for you.