Senior Analyst, Total Cost of Care

Healthfirst; New York (NY); On-site; USD 83,000 - 120,000; Full time

Benefits offered by this job

Benefits package

Job summary

Healthfirst, based in New York, seeks a Senior Analyst for Total Cost of Care to build analyses and tools monitoring financial performance across all products. The role serves as the analytics expert for medical cost trends, provider reimbursement, and data integrity within a fast-paced environment.

The ideal candidate has managed care or health economics experience, strong SAS/SQL and Excel skills, and the ability to translate complex data into actionable insights for Finance, Claims, and

Qualifications

• Bachelor's degree from an accredited institution.
• At least three (3) years of healthcare analytics experience, with at least two (2) years of contract evaluation, medical economics, medical cost containment, actuarial, or reimbursement model design.
• Extensive knowledge of managed care financial metrics (PMPM, util/k, cost/unit).
• Experience with healthcare claims data to uncover insights to improve financial performance.
• Experience with Government and proprietary payor reimbursement methodologies and unit cost management.
• Experience with SAS or SQL (creates queries and manipulation of data).
• Extensive experience with Microsoft Excel (financial models, pivot tables, VLOOKUP/index match).
• Claims experience with root-cause analysis, system set-up.

Responsibilities

• Develop actionable analytic tools to monitor medical cost and utilization trends and provide insights into root-cause drivers.
• Develop savings analyses for cost trend reduction initiatives using financial modeling.
• Prioritize cost mitigation activities across business areas.
• Provide data-driven analyses to Finance, Claims, Pharmacy, Payment Integrity, Medical Management, Network, and other departments.
• Evaluate data to identify root causes of payment integrity issues and drive cross-functional solutions.
• Develop interactive financial models to assess provider reimbursement changes.
• Support provider settlement and data reconciliation activities.
• Stay updated on NY Medicaid and Medicare reforms and their impact on Healthfirst performance.
• Perform ad hoc analyses.

Skills

SAS or SQL

Excel

Tableau

Python

Claims data analysis

Financial modeling

Project management

Communication skills

Education

Bachelor's Degree

Tools

SAS

SQL

Excel

Job description

Description and Requirements

The Senior Analyst, Total Cost of Care, will develop analyses and tools to help monitor financial performance and provide analytic insights into all products offered within the Healthfirst portfolio. This key role will serve as healthcare analytics and data subject matter expert, supporting all areas of medical trend, medical cost savings, provider network informatics, and reimbursement accuracy. The ideal candidate will come from a managed care, medical economics, insurance, actuarial, or hospital background, and will be a results-oriented individual who enjoys working in a fast-paced and challenging environment.

Hybrid Work Schedule:

This role will be onsite which consists of reporting to our 100 Church Street, New York, NY 10007 every Tuesday, Wednesday, and Thursday.

Scope of Responsibilities:

• Develop actionable analytic tools to help monitor medical cost and utilization trends, provide concise insight into the root cause drivers, and work with the team to develop potential remediation opportunities.
• Develop savings analyses for Medical Economics cost trend reduction initiatives, applying financial modeling expertise and using independent judgement to determine best valuation methods.
• Prioritization of cost mitigation activities across business areas.
• Provide actionable data driven analysis to Finance, Claims, Pharmacy, Payment Integrity, Medical Management, Network, and other departments to enable critical decision making.
• Evaluate data to identify and root cause of payment integrity issues and lead cross-functional efforts to problem solve.
• Develop interactive financial models to evaluate the impact of provider reimbursement changes.
• Support all provider settlement and data reconciliation activities.
• Keep abreast of New York Medicaid and Medicare reforms, reimbursement methodologies, and their impact on Healthfirst and their owner hospital performance.
• Perform ad hoc analyses.

Minimum Qualifications:

• Bachelor's Degree from an accredited institution.
• At least three (3) years of healthcare analytics experience, with at least two (2) years of experience in contract evaluation, medical economics, medical cost containment, actuarial, healthcare reimbursement model design
• Extensive knowledge of managed care financial metrics (PMPM, util/k, cost/unit).
• Experience utilizing healthcare claims data to uncover valuable insights to improve financial performance.
• Experience with Government and proprietary payor reimbursement methodologies and unit cost management.
• Experience with SAS or SQL (creates queries and manipulation of data).
• Extensive experience with Microsoft Excel (building financial models, utilizing pivot tables, VLOOKUP's, index match, and calculated fields).
• Claims experience including root-cause analysis, system set-up.
• Ability to work with large data sets.
• Strong written and verbal communication skills.
• Resourceful and creative in solving complex issues and working corroboratively with others on a solution.
• Ability to manage projects and project plans within stated timelines.

Preferred Qualifications:

• Expertise in 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.
• Understanding of value-based risk arrangements.
• Experience using Tableau, Python.
• Experience mentoring other team members.

Hiring Range :

• Greater New York City Area (NY, NJ, CT residents): $83,100 - $120,360
• All Other Locations (within approved locations): $73,400 - $109,225

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.

In addition to your salary, 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.

The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.

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 unemploym