Manager overseeing risk score accuracy for Healthfirst's Medicaid products, developing forecasting models and communicating financial results to senior management. Collaborate with clinical leaders to track performance metrics.
Responsibilities
Responsible for managing risk score expectations, communicating project and financial results and identifying areas of opportunity
Develop and maintain risk score forecasting models to track, measure and trend performance
Respond to requests for analysis and provide analytic support to the Product Managers, Actuarial department and Network/Hospital support
Manage and organize cross-departmental monthly meetings to discuss analysis requests and inform on the latest revenue trends
Keep abreast of New York Medicaid and CMS reforms and their impact on the health plan and sponsor hospital performance
Requirements
Bachelor’s degree from an accredited institution
At least 5 years previous work experience within risk adjustment, grouper analysis or other statistical/clinical analysis
Experience with Medicaid/HHS risk adjustment payment methodologies
Proficiency in SQL (Script Development, Joins) – using PostgreSQL, MS SQL Server, MySQL and Advanced MS Excel Skills (Pivot Table Creation, Complex formula development)
Data Visualization Experience (Tableau or Qlik View or Power BI)
Strong project management experience and ability to handle multiple projects in a fast-paced environment.
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