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Healthfirst · 14 hours ago

Manager, Risk Score Accuracy

New York, NY

Full-time

Hybrid

Mid, Senior Level

$103K/yr - $149K/yr

5+ years exp

Healthfirst is New York’s largest not-for-profit health insurer, focused on high quality of care and better patient outcomes. The Manager, Risk Score Accuracy will manage risk score expectations, communicate project and financial results, and identify areas of opportunity for Healthfirst and hospital senior management.

Commercial InsuranceHealth CareHealth InsuranceInsurance

Responsibilities

Develop and maintain risk score forecasting models to track, measure and trend performance for NYS PHSP products including Medicaid, Essential Plan, HARP, CHPlus and MLTC

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 to 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

Qualification

SQLRisk adjustment experienceData visualizationStatistical analysisProject managementPythonCommunication skillsProblem solvingInterpersonal skills

Required

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)

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

Preferred

At least 7 years previous work experience within risk adjustment, grouper analysis or other statistical//clinical analysis

Experience with NYS Medicaid risk adjustment payment methodologies and CRG models

Experience working with data obtained from UAS results for LTC products

Data Visualization Experience (Tableau or Qlik View or Power BI)

Python Scripting

Credentialed Associate of the Society of Actuaries (ASA)

Ability to effectively and efficiently adapt in a dynamic environment

Ability to challenge the status quo and drive lean implementation

Ability to quickly develop an understanding of systems and technology

Ability to effectively communicate with all levels of the organization, including senior leadership, technical staff, internal nontechnical staff, and business stakeholders