Sr Risk Adjustment Analyst

About HealthFirst Healthfirst believes that every New Yorker deserves access to the best available healthcare. As one of New York’s highest quality not-for-profit health insurers serving close to two million New Yorkers, we make this a reality for our members. Founded more than 30 years ago by the leading hospital systems in downstate New York, Healthfirst established a partnership model that enables hospitals, health systems, and physicians in our network to prioritize health outcomes over profits, placing the needs of our members and community first. Healthfirst serves members in New York City, on Long Island, and in Westchester, Rockland, Sullivan, and Orange counties, offering market-leading products to suit every life stage. Our offerings include Medicaid plans, Medicare Advantage plans, Child Health Plus plans, Essential Plans, Long-Term Care plans, and Qualified Health plans. For more information on Healthfirst, please visit healthfirst.org.

HealthFirst

We provide no-and low-cost health insurance in NYC, Long Island, Orange, Rockland, Sullivan, and Westchester counties.

One of New York's largest providers of MedicareMedicaidFamily Health Plus (FHP)Child Health Plus (CHP)Value Based PaymentsSmall BusinessMedicareGroup Insuranceindividual insuranceHealth Plan

H

healthfirst.org

1,001-5,000 employees

Hospitals and Health Care

New York, NY

1993

Nonprofit

80k LinkedIn followers

• 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

Required

• 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

Preferred

• 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
• All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.
• 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.

• Medical coverage
• Dental coverage
• Vision coverage
• Incentive programs
• Recognition programs
• Life insurance
• 401k contributions