Healthfirst

Positioned in the Finance Department, the Manager – Risk Score Accuracy will be responsible for analytics supporting risk score accuracy through developing and managing forecasting models to support budgets and quarterly forecasts and interface with various departments across the organization to ensure appropriate explanations of any material variances to expectations. This candidate will also own the processes that support all audit activities as it relates to Medicare RADVs and OIG audits. This position requires someone who is adept at problem solving, possesses strong SQL coding skills and an ability to communicate effectively with internal & external constituents. The Manager of Risk Score Accuracy is responsible for managing risk score expectations, communicating financial results, supporting audits and identifying areas of opportunity for Healthfirst and hospital senior management. The Manager of Risk Score Accuracy will be the lead on a broad set of projects across the department.

Duties:

• Develop and maintain risk score forecasting models to assist Actuarial in budget, quarterly forecasting and bid
• Manage revenue trend models and identify route cause of developing trends.
• Manage monthly analysis for analytical meetings discussing variances to budget.
• Manage all analytical audit requests as they relate to Medicare RADV and OIG and prepare financial impacts estimations.
• Respond to requests for analysis and provide analytic support to the Product managers and actuarial department.
• Pull data from the warehouse using Statistical Analysis System (SAS)/Structured Query Language (SQL) code and generate reports using SAS.
• 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 Medicare reforms and their impact on the health plan and owner hospital performance.

Minimum Requirements:

• Bachelor’s degree from an accredited institution.
• At least 5 years previous work experience within risk adjustment
• Credentialed Associate of the Society of Actuaries (ASA)
• 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 financial impact of risk revenue changes.
• Experience in supporting Product and Actuarial analytical requests.
• Experience with CMS/HHS risk adjustment payment methodologies.
• 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:

• At least 7 years previous work experience within risk adjustment
• Data Visualization Experience (Tableau or Qlik View or Power BI).
• Python Scripting.
• 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

Location:

• Hybrid, NY (3 days on-site per week) – 100 Church Street, NYC

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $100,900 - $145,775

• All Other Locations (within approved locations): $86,500 - $128,690

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. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.