Sr Risk Adjustment Analyst

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 departments 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.

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.