Sr Risk Adjustment Analyst

The HCA will interact with divisional subject matter experts, clinical partners, finance, and other areas of the organization to provide support in various tasks related to achieving business objectives. The HCA will contribute to a broad set of projects across the department. This position requires an individual with emerging skills who enjoys working in a fast paced and challenging environment.

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 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

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