Sr Risk Adjustment Analyst

Healthfirst; Layton (UT); On-site; USD 65,000 - 109,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Incentive programs

Life insurance

401k contributions

Job summary

Healthfirst is seeking a Senior Healthcare Analyst to research and investigate business issues related to cost, utilization, and revenue data for Healthfirst products. You will identify trends, develop recommendations, and communicate findings to management.

The role involves building financial models, gathering data, conducting ad hoc analyses, and supporting cost-reduction initiatives. Collaboration with clinical partners, finance, and other departments is essential to drive business

Qualifications

• Bachelor's degree or higher in Finance, Accounting, Business, Public Health, Healthcare Policy, or Healthcare Administration.
• 3+ years of related experience.
• Self-motivated, creative problem solver with strong communication and interpersonal skills.
• Strong project management experience in a fast-paced environment.
• Experience in healthcare settings.
• Experience analyzing medical cost and utilization trends.
• Excel proficiency.

Responsibilities

• Analyze the financial performance of Healthfirst products and identify trends; develop recommendations for management.
• Create financial models to evaluate provider reimbursement changes.
• Gather data and conduct ad hoc analyses; assist with analytical reports.
• Support department projects related to medical cost reduction initiatives.
• Assist with RoI analyses for vendors; assess financial and clinical performance.
• Monitor Medicaid/Medicare reforms and their impact on Healthfirst performance.
• Support performance improvement work groups and cross-functional teams.
• Monitor costs and revenue trends and explain their drivers.
• Analyze impacts of new program changes on provider organizations.
• Maintain and update analysis logs and project plans.

Skills

Excel

Project management

Communication

Education

Bachelor's degree in Finance/Accounting/Business/Public Health/Healthcare Policy/Healthcare Administration

Tools

SAS

Python

R

Tableau

Job description

The Senior Healthcare Analyst provides support through the research and investigation of business issues related to cost, utilization, and revenue data for multiple Healthfirst products. The HCA will identify/monitor cost and utilization trends and the root causes in health plan trend performance and provide recommendations for solutions.

The HCA will interact with divisional subject matter experts, clinical partners, finance, and other areas of the organization to provide support in various tasks related to achieving business objectives. The HCA will contribute to a broad set of projects across the department. This position requires an individual with emerging skills who enjoys working in a fast paced and challenging environment. The HCA works in partnership with other areas of Finance to provide key insights and analysis to our internal stakeholders across departments like operations and medical management as well as our external hospital and provider networks.

Job Description

• 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.
• 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.
• 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.

Minimum Requirements

• Bachelor's degree or higher from an accredited institution with a concentration in Finance, Accounting, Business, Public Health, Healthcare Policy, or Healthcare Administration.
• 3+ years of related experience.
• 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.
• Current or previous work experience in healthcare.
• Experience with analyzing medical cost and utilization trends.
• Knowledge of Medicaid and Medicare programs.
• Skills in Excel.

Preferred Qualifications

• Experience in modeling financial impact of provider reimbursement changes.
• Skills in SAS, Python, R, Tableau, or a similar coding language.
• Experience in modeling financial impact of provider reimbursement changes.

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.

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.

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

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.