Senior Healthcare Analyst, Risk Adjustment

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

Benefits offered by this job

Medical, dental, and vision coverage

Life insurance

401k contributions

Incentive programs

Job summary

Healthfirst is seeking a Senior Healthcare Analyst, Risk Adjustment to monitor performance, forecast risk scores, and deliver insights for executive leadership. You will partner with Finance, Actuarial, and Network Management to drive accuracy and timely reporting.

The role emphasizes advanced analytics, process automation with Python/SQL, and collaboration across departments in a fast-paced healthcare environment.

Qualifications

• 3+ years of related risk adjustment experience.
• Bachelor's degree or higher in Finance, Accounting, Public Health, Healthcare Policy, or Healthcare Administration.
• Deep understanding of CMS-HCC, HHS-HCC, and/or Medicaid Rx risk adjustment.
• Familiarity with Medicare/Medicaid data submission systems (EDPS, RAPS).
• Strong communication and collaboration skills for cross-functional work.

Responsibilities

• Provide ad-hoc analytical support for Medicare initiatives and risk adjustment drivers.
• Forecast risk scores and assist budgeting; evaluate impact on revenue.
• Develop Python/SQL processes to calculate and validate accruals.
• Collaborate with Finance, Actuarial, Network Management, and stakeholders.
• Summarize complex data into actionable insights for senior leadership.

Skills

Analytical mindset

Collaborative

Project management

Communication skills

Problem solving

Time management

Attention to detail

Education

Bachelor's degree or higher in Finance/Accounting/Public Health/Healthcare Administration

Tools

SAS

Python

R

Tableau

SQL

Job description

The Senior Healthcare Analyst, Risk Adjustment is responsible for monitoring risk adjustment performance, communicating financial results, and identifying areas of opportunity for Healthfirst and hospital senior management. This role contributes to a broad range of departmental initiatives, including evaluating performance trends, forecasting risk scores, and supporting internal reporting and analysis. The Senior Healthcare Analyst works closely with Finance and cross-functional partners to deliver meaningful insights that support informed decision-making. Key stakeholders include Actuarial, Medicare and State Products, and hospital and provider reporting and analytics teams. This position is well suited for an analytical, collaborative professional who is continuing to develop their expertise and thrives in a fast-paced, challenging environment.

Duties & Responsibilities:

• Provide ad-hoc analytical support for Medicare initiatives, including evaluating risk adjustment impacts, emerging financial trends, and other drivers of plan and provider performance
• Assist with the forecasting and budgeting of Medicare risk scores by analyzing historical and emerging trends, developing projections, evaluating key risk adjustment drivers, and assessing the resulting impact on revenue and financial performance
• Crosstrain on Medicare and Commercial accrual processes to provide backup support and strengthen understanding of monthly financial close and reporting activities
• Develop and maintain Python/SQL-based processes used to calculate, validate, and analyze Medicare and Commercial accruals, with a focus on accuracy, reproducibility, and process efficiency
• Partner with Finance, Actuarial, Network Management, and other stakeholders to investigate accrual variances, reconcile results, and explain key drivers of month-over-month changes
• Summarize complex financial and operational data into clear, actionable insights and effectively communicate findings, key trends, and recommendations to stakeholders at various levels of the organization, including senior leadership and executive management
• 3+ years of related risk adjustment experience
• Bachelor's degree or higher from an accredited institution with a concentration in Finance, Accounting, Business, Public Health, Healthcare Policy, or Healthcare Administration
• Deep understanding of CMS-HCC (Medicare Advantage), HHS-HCC (Commercial/ACA), and/or Medicaid Rx risk adjustment methodologies
• Solid grasp of medical coding classification systems, including ICD-10-CM, CPT, and HCPCS, and how they map to Hierarchical Condition Categories (HCCs)
• Familiarity with government data submission processes such as EDPS (Encounter Data Processing System) and RAPS (Risk Adjustment Processing System)
• Self-motivated, creative problem solver who can work independently and collaborate through strong communication and interpersonal skills
• Strong project management experience and ability to handle multiple projects in a fast-paced environment
• Experience with analyzing medical cost and utilization trends
• Working knowledge of Medicaid and Medicare programs
• Well versed in Excel ( pivot table creation, complex formula development)
• Must be able to work a hybrid schedule consisting of reporting to our 100 Church Street, NYC office every Tuesday, Wednesday & Thursday

Preferred Qualifications:

• Actuary experience and/or background
• Experience in modeling financial impact of provider reimbursement changes
• Skills in SAS, Python, R, Tableau, or a similar coding language

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 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