Summary: • The Healthcare Analyst (HCA) provides support through the research and investigation of business issues related to cost, utilization, and revenue data for multiple Healthfirst products. • The HCA will identify/monitor cost and utilization trends and the root causes in health plan trend performance and provide recommendations for solutions. • The HCA will interact with divisional subject matter experts, Network, and IT 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. • The HCA works in partnership with other areas of Finance to provide key insights and analysis to our internal stakeholders across departments like operations and medical management as well as our external hospital and provider networks.
Work Schedule
Duties & 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
Minimum Requirements:
Bachelor's degree or higher from an accredited institution with a concentration in Finance, Accounting, Business, or Healthcare Administration
Familiarity with 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
Experience in modeling financial impact of provider reimbursement changes
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.
Knowledge of statistical methodologies and tools, including experimentation design
Demonstrated success analyzing large datasets
Excel (pivot table creation, complex formula development, sum-ifs, and VLOOKUP's
SQL: Proficient - minimum 2-3 years of experience with ability to use aggregate & window functions, group by, temp tables, subqueries, CTEs and optimize queries involving complex joins with millions of rows of data.
AWS: proficiency with Redshift and S3 or similar cloud data warehouse solutions
Familiarity with data models and/or data modelling
Experience with Alteryx, Tableau, Amazon Redshift, QlikView, or other similar tools/platforms
Preferred Requirements:
Experience with analyzing medical cost and utilization trends
Current or previous work experience with a Health insurance company
Advanced skills in SAS
Python: Familiarity (1 year)
R: Familiarity helpful
Knowledge of Medicaid and Medicare programs
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
Utilize statistical tools to identify, analyze, and interpret patterns and trends in complex data sets
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
Hiring Range*:
Greater New York City Area (NY, NJ, CT residents): $68,900 - $99,620
All Other Locations (within approved locations): $61,300 - $91,120
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.
61300-91120
