Risk Adjustment, Financial Analyst (Hybrid NY)

About the role

The Healthcare Analyst (HCA) 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 and 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, Network, IT, 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 internal stakeholders across departments like operations and medical management as well as external hospital and provider networks.

Responsibilities

• Analyze the financial performance of all Healthfirst products, identify favorable and unfavorable trends, develop recommendations to improve trends, and 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.

Requirements

• Bachelor's degree or higher from an accredited institution with a concentration in Finance, Accounting, Business, Healthcare Administration, or related field.
• Experience in modeling financial impact.
• Self-motivated, creative problem solver who can work independently and collaborate through strong communication and interpersonal skills.
• Strong time management experience and ability to handle multiple projects in a fast-paced environment.
• Knowledge of statistical methodologies and tools, including experimentation design.

Skills

• Demonstrated success analyzing large datasets.
• Advanced proficiency in Excel.
• Proficiency in SQL, Python, SAS, or R.
• Proficiency with Redshift and S3 or similar cloud data warehouse solutions.
• Familiarity with data models and/or data modeling.
• Experience with Alteryx, Tableau, Amazon Redshift, QlikView, or other similar tools/platforms.

Preferred Requirements

• Demonstrated understanding of 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.
• Experience analyzing medical cost and utilization trends.
• Current or previous work experience with a health insurance company.
• Knowledge of Medicaid and Medicare programs.
• 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.
• Utilize statistical tools to identify, analyze, and interpret patterns and trends in complex data sets.
• 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.

Pay

Hiring range for the Greater New York City Area (NY, NJ, CT residents): $68,900 – $99,620. For all other locations (within approved locations): $61,300 – $91,120. Salary and related elements of compensation are contingent upon work experience, education, licenses and certifications, and other factors Healthfirst deems pertinent to the hiring decision.

Benefits

• Medical, dental, and vision coverage.
• Incentive and recognition programs.
• Life insurance.
• 401k contributions (all benefits are subject to eligibility requirements).