This role will be onsite at 100 Church Street, New York, NY 10007 on Tuesdays, Wednesdays, and Thursdays.
Responsibilities
• Develop actionable analytic tools to help monitor medical cost and utilization trends, provide concise insight into the root cause drivers, and work with the team to develop potential remediation opportunities.
• Develop savings analyses for Medical Economics cost trend reduction initiatives, applying financial modeling expertise and using independent judgement to determine best valuation methods.
• Prioritization of cost mitigation activities across business areas.
• Provide actionable data driven analysis to Finance, Claims, Pharmacy, Payment Integrity, Medical Management, Network, and other departments to enable critical decision making.
• Evaluate data to identify and root cause of payment integrity issues and lead cross-functional efforts to problem solve.
• Develop interactive financial models to evaluate the impact of provider reimbursement changes.
• Support all provider settlement and data reconciliation activities.
• Support maintenance of tools to define profitability dashboards by product.
• Keep abreast of New York Medicaid and Medicare reforms, reimbursement methodologies, and their impact on Healthfirst and their owner hospital performance.
• Perform ad hoc analyses.
Minimum Qualifications
• Bachelors Degree from an accredited institution.
• At least three (3) years of healthcare analytics experience, with at least two (2) years of experience in contract evaluation, medical economics, medical cost containment, actuarial, healthcare reimbursement model design
• Extensive knowledge of managed care financial metrics (PMPM, util/k, cost/unit).
• Experience utilizing healthcare claims data to uncover valuable insights to improve financial performance.
• Experience with Government and proprietary payor reimbursement methodologies and unit cost management.
• Experience with SAS or SQL (creates queries and manipulation of data).
• Extensive experience with Microsoft Excel (building financial models, utilizing pivot tables, vlookups, index match, and calculated fields).
• Claims experience including root-cause analysis, system set-up, etc
• Ability to work with large data sets.
• Strong written and verbal communication skills.
• Resourceful and creative in solving complex issues and working corroboratively with others on a solution.
• Ability to manage projects and project plans within stated timelines.
Preferred Qualifications
• Expertise in key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRGs), Ambulatory Patient Groups (APGs), Ambulatory Payment Classifications (APCs), and other payment mechanisms.
• Understanding of value-based risk arrangements.
• Experience using Tableau, Python
• Experience mentoring other team members.
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.
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