Senior Healthcare Analyst, Risk Adjustment

Healthfirst; New York (NY); Híbrido; USD 73.000 - 120.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental and vision coverage

Life insurance

401(k) contributions

Incentive programs

Descripción de la vacante

Healthfirst is seeking a Senior Healthcare Analyst, Risk Adjustment in New York, NY. The role focuses on monitoring risk adjustment performance, forecasting risk scores, and communicating financial results to senior management.

Collaboration with Finance, Actuarial, and clinical teams is essential for delivering insights and improving plan performance. The ideal candidate has 3+ years in risk adjustment, a related degree, and strong analytics skills.

Formación

• 3+ years of related risk adjustment experience
• Bachelor's degree or higher 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 risk adjustment methodologies
• Solid grasp of ICD-10-CM, CPT, HCPCS and their mapping to HCCs
• Familiarity with EDPS and RAPS data submissions
• Strong communication and interpersonal skills
• Strong project management experience and ability to handle multiple projects
• 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)
• Hybrid work schedule at 100 Church Street, NYC office Tue–Thu

Responsabilidades

• Provide ad-hoc analytical support for Medicare initiatives, including evaluating risk adjustment impacts and emerging financial trends
• Assist with forecasting and budgeting of Medicare risk scores by analyzing historical trends and projections
• Crosstrain on Medicare and Commercial accrual processes to support monthly close and reporting
• Develop and maintain Python/SQL-based processes to calculate and analyze accruals with accuracy and efficiency
• Partner with Finance, Actuarial, Network Management to investigate accrual variances and explain drivers
• Summarize complex financial data into actionable insights and communicate findings to stakeholders and senior leadership

Conocimientos

Analytical thinking

Communication

Project management

Problem solving

Educación

Bachelor's degree or higher (Finance/Accounting/Business/Public Health/Healthcare Admin)

Herramientas

Python

SQL

Excel

Descripción del empleo

Description and Requirements

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

Minimum Requirements:

• 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 certificates, 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.