Job Information
Healthfirst Sr Healthcare Analyst, LTCP Risk Score Accuracy - Hybrid NY in United States
Location:
- This is a hybrid role which consists of working at 100 Church Street, New York, NY 10007 on Tuesdays, Wednesdays, and Thursdays.
Summary:
The Sr Healthcare Analyst, LTCP Risk Score Accuracyis responsible for managing risk score expectations, communicating project and financial results and identifying areas of opportunity for Healthfirst and hospital senior management.
The Sr Healthcare Analyst, LTCP Risk Score Accuracywill be the lead on LTCP risk adjustment projects across the department.
You will be:
Develop and maintain risk score forecasting models to track, measure and trend performance for LTCP products including MLTC and MAP.
Respond to requests for analysis and provide analytic support to the Product Managers, Actuarial department and Network/Hospital support.
Manage and organize cross-departmental monthly meetings to discuss analysis requests, inform on the latest revenue trends, and to keep abreast of the changes occurring in our provider community.
Keep abreast of New York Medicaid and CMS reforms and their impact on the health plan and sponsor hospital performance.
Pull data from the warehouse using SQL code and generate reports.
Minimum Requirements:
Bachelors degree from an accredited institution with a concentration in Mathematics, Computer Science, Data Science, Engineering, Business Analytics or similar field.
At least 5 years previous work experience within risk adjustment, grouper analysis or other statistical/clinical analysis
Experience with Medicaid/HHS risk adjustment payment methodologies.
Proficiency in SQL (Script Development, Joins) using PostgreSQL, MS SQL Server, MySQL and Advanced MS Excel Skills (Pivot Table Creation, Complex formula development).
Data Visualization Experience (Tableau or Qlik View or Power BI).
Experience in modeling the enterprise impact of risk/value-based revenue changes.
Experience in supporting Product and Actuarial analytical requests.
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.
Preferred Qualifications:
Experience with NYS Medicaid risk adjustment payment methodologies and CRG models.
Experience working with data obtained from UAS results for LTCP products
Data Visualization Experience (Tableau or Qlik View or Power BI).
Python Scripting.
Credentialed Associate of the Society of Actuaries (ASA)
Ability to effectively and efficiently adapt in a dynamic environment
Ability to challenge the status quo and drive lean implementation
Ability to quickly develop an understanding of systems and technology
Ability to effectively communicate with all levels of the organization, including senior leadership, technical staff, internal nontechnical staff, and business stakeholders
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.