Duties & Responsibilities:

• Value new medical cost initiatives, applying financial modeling expertise and using independent judgement to determine the best methods and approaches to calculate accurate estimates of program savings.

• Provide data driven analysis to Finance, Claims, Medical Management, Network, and other departments to enable critical decision making.

• Coordinate program implementation with initiative owners and establish controls to validate that changes have occurred.

• Thoroughly vet and perform due diligence on potential value-based arrangements to assess financial impact, ensure operational feasibility, and identify impact on existing programs.

• Identify favorable and unfavorable performance trends within medical cost initiatives, communicate trends to leadership, and recommend changes to initiative owners to improve performance.

• Perform complex return on investment analyses for vendors to determine if their financial and clinical performance is achieving desired results.

• Keep abreast of New York Medicaid and Medicare reforms and their impact on Healthfirst and their owner hospital performance.

Minimum Qualifications:

• Bachelors degree from an accredited institution.

• Analytical work experience within the healthcare industry (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)

• Work experience with SQL where you have created SQL queries, pulled large data sets, and performed data manipulations/analysis .

• Experience with MS Excel functions that include working with large data sets, creating standardized reports, utilizing VLOOKUP and advanced functions/ formulas, creating, using, and interpreting pivot tables, filtering, and formatting .

• Knowledge of healthcare financial terms such as cost, utilization, Per Member Per Month (PMPM) and revenue.

• Basic understanding of Medicaid and Medicare programs or other healthcare plans.

• Self-motivated, creative problem solver who can work independently and collaborate through strong communication and interpersonal skills.

Preferred Qualifications:

• Bachelors degree or higher from an accredited institution with a concentration in Finance, Accounting, Business, or Healthcare Administration.

• Strong project management experience and ability to handle multiple projects in a fast-paced environment.

• Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRGs), Ambulatory Patient Groups (APGs), Ambulatory Payment Classifications (APCs), and other payment mechanisms.

• Experience using Tableau.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.