AVP leading talent development and risk control strategies for national accounts at Travelers. Managing and executing business plans with a focus on analytics and resource allocation.
About the role
- Sr Healthcare Analyst managing risk score accuracy at Healthfirst. Develops forecasting models and analyzes data to support healthcare management in New York.
Responsibilities
- Responsible for risk score accuracy through developing and managing forecasting models to support budgets and quarterly forecasts.
- Interface with various departments across the organization to ensure appropriate explanations of any material variances to expectations.
- Work closely with HF clinical leaders to create successful metrics, track progress, and communicate results.
- Develop and maintain risk score forecasting models to track, measure and trend performance for LTCP products including MLTC and MAP.
- 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, inform on the latest revenue trends, and keep abreast of the changes occurring in our provider community.
- Keep abreast of New York Medicaid and CMS reforms and their impact on the health plan and sponsor hospital performance.
- Pull data from the warehouse using SQL code and generate reports.
Requirements
- Bachelor’s degree from an accredited institution with a concentration in Mathematics, Computer Science, Data Science, Engineering, Business Analytics or similar field.
- 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).
- Experience in modeling the enterprise impact of risk/value-based revenue changes.
- Experience in supporting Product and Actuarial analytical requests.
- 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.
Benefits
- medical, dental and vision coverage
- incentive and recognition programs
- life insurance
- 401k contributions
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