Senior Analyst, Total Cost of Care - Hybrid NY

Scope Of Responsibilities

• Develop actionable analytic tools to help monitor medical cost and utilization trends, provide concise insight into the root cause drivers, and work with the team to develop potential remediation opportunities.
• Develop savings analyses for Medical Economics cost trend reduction initiatives, applying financial modeling expertise and using independent judgement to determine best valuation methods.
• Prioritize cost mitigation activities across business areas.
• Provide actionable data-driven analysis to Finance, Claims, Pharmacy, Payment Integrity, Medical Management, Network, and other departments to enable critical decision-making.
• Evaluate data to identify and root cause of payment integrity issues and lead cross-functional efforts to problem-solve.
• Develop interactive financial models to evaluate the impact of provider reimbursement changes.
• Support all provider settlement and data reconciliation activities.
• Support maintenance of tools to define profitability dashboards by product.
• Keep abreast of New York Medicaid and Medicare reforms, reimbursement methodologies, and their impact on Healthfirst and their owner hospital performance.
• Perform ad hoc analyses.

Minimum Qualifications

• Bachelor’s Degree from an accredited institution.
• At least three (3) years of healthcare analytics experience, with at least two (2) years of experience in contract evaluation, medical economics, medical cost containment, actuarial, healthcare reimbursement model design.
• Extensive knowledge of managed care financial metrics (PMPM, util/k, cost/unit).
• Experience utilizing healthcare claims data to uncover valuable insights to improve financial performance.
• Experience with Government and proprietary payor reimbursement methodologies and unit cost management.
• Experience with SAS or SQL (creates queries and manipulation of data).
• Extensive experience with Microsoft Excel (building financial models, utilizing pivot tables, vlookups, index match, and calculated fields).
• Claims experience including root-cause analysis, system set-up, etc.
• Able to work with large data sets.
• Strong written and verbal communication skills.
• Resourceful and creative in solving complex issues and working corroboratively with others on a solution.
• Able to manage projects and project plans within stated timelines.

Preferred Qualifications

• Expertise in 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.
• Understanding of value-based risk arrangements.
• Experience using Tableau, Python.
• Experience mentoring other team members.