Healthcare Analyst

Healthfirst is hiring a Healthcare Analyst to research business issues and analyze cost, utilization, and revenue data across its health plan products. The role identifies trends and their causes, develops recommendations, and provides financial and analytical support for projects and stakeholders across the organization.

Responsibilities

• Analyze the financial performance of all Healthfirst products, identify favorable and unfavorable trends, develop recommendations to improve trends, and 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

Preferred

• Current or previous work experience with a Health insurance company
• Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms
• Skills in SAS, SQL, R, Tableau, or a similar coding language
• Experience in modeling financial impact of provider reimbursement changes
• Health insurance experience
• Managed care concepts
• Provider reimbursement
• Risk adjustment
• Capitation
• Fee-for-service (FFS)
• Diagnosis-related groups (DRGs)
• Ambulatory patient groups (APGs)
• Ambulatory payment classifications (APCs)
• Payment mechanisms
• SAS
• SQL
• R
• Tableau
• Coding languages
• Financial impact modeling
• Provider reimbursement change modeling

Benefits

• Hybrid work schedule: reporting to the 100 Church Street, NYC office every Tuesday, Wednesday & Thursday.
• Medical, dental and vision coverage, subject to eligibility requirements.
• Incentive and recognition programs, subject to eligibility requirements.
• Life insurance, subject to eligibility requirements.
• 401k contributions, subject to eligibility requirements.

Company

• New York health insurer offering Medicaid and Medicare Advantage plans
• New York, New York, USA
• https://healthfirst.org/
• Founded in 1993
• 1001-5000 employees

Qualifications

• Bachelor's degree or higher from an accredited institution with a concentration in Finance, Accounting, Business, Public Health, Healthcare Policy, or Healthcare Administration
• 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
• Experience with analyzing medical cost and utilization trends
• Knowledge of Medicaid and Medicare programs
• Intermediate skills using MS Excel
• Current or previous work experience with a Health insurance company
• Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms
• Skills in SAS, SQL, R, Tableau, or a similar coding language
• Experience in modeling financial impact of provider reimbursement changes

Required skills

• Capitation, Fee-for-Service (FFS), Financial Impact Modeling, Managed Care, Medicaid, Medical Cost and Utilization Trend Analysis, Medicare, Provider Reimbursement, R, Risk Adjustment, SAS, SQL, Tableau

Preferred skills

• Skills in SAS, SQL, R, Tableau, or a similar coding language

Experience

• Mid level