Healthfirst

Positioned in the Finance Department, the Healthcare Analyst – Risk Score Accuracy will be responsible for supporting the risk score accuracy team through performing analyses that will validate and optimize the efficacy of our operational activities. This candidate will support and own processes that support our collaboration in the delivery system or through the vendors we have contracted with for scale. This position requires someone who is adept at problem solving, possesses strong SQL coding skills and an ability to communicate effectively to internal and external constituents. Who we are: Healthfirst was founded by a collection of major healthcare systems in the New York area to emphasize high quality of care, and better patient outcomes. We have grown into New York’s largest not-for-profit health insurer that covers members in New York City and on Long Island, as well as in Westchester, Sullivan, Orange, and Rockland counties. Healthfirst accomplishes this all while collaborating with our hospital sponsors, provider partners, and provider delivery system via our value-based model. More about the team, and the role: Transactional healthcare data is the lifeline for our value-based payment model. The Risk Adjustment & Encounters Reporting team is unique, as it relies on establishing workstreams and developing partnerships across the care continuum to ensure that the member’s health status is accurately represented through encounters prior to their submission to Centers for Medicare & Medicaid Services, and the New York State Department of Health. As a Healthcare Analyst – your role will be critical towards our efforts for accurate risk scores.

Duties & Responsibilities:

• Prepare and update financial reporting packages
• Produce financial Reports for Healthfirst Risk Partners.
• Perform drill down analyses to identify the root causes for medical cost and utilization trend
• Document all coding, methodology and assumptions, data issues and report result for each analysis.
• Utilize research methods to analyze various data sets to support material financial adjustments for all Healthfirst products.
• Gather data and conduct ad-hoc analyses as directed by other Finance team members and assist with the development of reports.
• Keep abreast of New York Medicaid and Medicare reforms and their impact on the health plan and product performance

Minimum Requirements:

• Bachelor’s degree from an accredited institution
• Proficiency in SQL (Script Development, Joins) – using PostgreSQL, MS SQL Server, MySQL and Advanced MS Excel Skills (Pivot Table Creation, Complex formula development)
• Ability to communicate effectively across multiple functional areas within an organization.
• Ability to present findings and deliver actionable items as a result of findings.

Preferred Qualifications:

• Bachelor’s degree in healthcare administration or healthcare Finance
• Previous work experience within the Healthcare Industry; especially within risk adjustment (Data Analysis, Managing vendor relationships, operational workstream creation)
• Data Visualization Experience (Tableau or Qlik View or, Power BI)
• Python Scripting

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $67,200 - $97,155

• All Other Locations (within approved locations): $59,800 - $88,910

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.