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About the role
- 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.
Benefits
- medical, dental and vision coverage
- incentive and recognition programs
- life insurance
- 401k contributions
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