Healthcare Analyst

at  Healthfirst

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 QUALIFICATIONS:

• Bachelor’s 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, utilizing vLookups and 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 a fast paced environment.
• 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.
• Understanding of value-based risk arrangements.

Please refer the Job description for details