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 Qualifications:
Bachelors degree from an accredited institution, ideally in Finance, Math, Statistics or Computer Science.
Experience with SQL highly preferred, but SAS is also acceptable.
Experience with MS Excel functions that include working with large data sets, creating standardized reports, utilizingvLookupsand advanced functions/formulas;creating, using and interpreting pivot tables, filtering and formatting.
Experience using Tableau or other Data Visualization tools (Power BI, etc)
Self-motivated, creative problem solver who can work independently and collaborate through strong communication and interpersonal skills.
Preferred Qualifications:
Basic understanding of Medicaid and Medicare programs or other healthcare plans.
Strong project management experience and ability to handle multiple projects in afast pacedenvironment.
Demonstrated understanding of 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 ofvalue-basedrisk arrangements.
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.
