Sr Risk Adjustment Analyst

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

Job summary

Healthfirst is seeking a Senior Healthcare Analyst in the Greater New York City area. The role analyzes financial performance, costs, and utilization across Healthfirst products, building models to evaluate provider reimbursement changes and ROI for vendors.

You will gather data, perform ad hoc analyses, and present insights to internal stakeholders across departments such as operations and medical management. A healthcare background and 3+ years of experience are required.

Qualifications

• Bachelor's degree or higher from an accredited institution with a concentration in Finance, Accounting, Public Health, Healthcare Policy, or Healthcare Administration.
• 3+ years of related experience.
• Self-motivated problem solver with 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.

Responsibilities

• Analyze the financial performance of Healthfirst products, identify trends, and communicate recommendations to management.
• Create financial models to evaluate the impact of provider reimbursement changes.
• Gather data and perform ad hoc analyses for analytical reports.
• Support department projects related to medical cost reduction initiatives.
• Assist with RoI analyses for vendors to assess performance results.
• Monitor New York Medicaid and Medicare reforms and their impact on Healthfirst.
• Support the department’s performance improvement work groups.
• Monitor costs and revenue trends and analyze their drivers.
• Understand impacts of new program changes.
• Create, modify, and update analyses for Provider Organizations.
• Conduct contract analysis and model fee schedules.
• Maintain project logs and work plans; perform additional duties as assigned.

Skills

Excel

Cost analysis

Utilization trends

Project management

Communication

Education

Bachelor's degree or higher in Finance, Accounting, Public Health, Healthcare Policy, or 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.
• Additional duties as assigned

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

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.