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.
Vice President of Data Governance responsible for data strategy and governance at Universal Music Group. Leading cross - functional initiatives to optimize data management and compliance.
Senior Operations Risk Manager at Manulife handling global operational risk initiatives. Leading risk governance programs and collaborating with senior leadership in the insurance sector.
Senior Risk Control Consultant at Travelers providing account evaluations and risk management solutions. Collaborating with Underwriters and maintaining customer relationships in the Construction sector.
Loss Mitigation Analyst role in Customer Asset Management tackling operational risk and compliance. Collaborating on reporting and process improvement initiatives to enhance workflows across teams.
Head of Insurance and Risk overseeing risk governance and insurance strategies for Circle K. Leading casualty claims management and collaboration across operational teams in a global company.
Risk Manager overseeing fiduciary activities within Personal Trust and Investments across Wealth Management at U.S. Bank. Collaborating with senior leadership to ensure compliance and manage risks.
Associate Director managing environmental and social risks at RBC, supporting account managers and enhancing financial stability through effective risk management.
Assistant Manager - IT Risk Management leading day - to - day operations of information security strategies at S&C Electric. Collaborating with IT teams to safeguard digital assets and mitigate cyber threats.