Healthfirst Sr. Healthcare Analyst in New York, New York
The Senior Healthcare Analyst provides support to the Network Analytics team and Medical Economics department by performing functions that enable key decisions within the Network. The Senior Healthcare Analyst will use provider, member and claims data to support various tasks to achieve business objectives. This position requires an individual with skills in areas of Network and Healthcare. You must also be someone who enjoys working in a fast passed and challenging environment.
Duties & Responsibilities:
Analyze medical claims data to support the network teams with a variety of provider related decisions.
Create plug and play financial impact models, to evaluate the impact of provider contract changes.
Conduct ad-hoc analyses as requested by the Finance, Network Management , Operations, Regulatory, Legal, and other departments and assist with the development and presentation of analytical data reports.
Conduct claims settlement analyses determining if claims were paid correctly.
Effectively communicate analysis findings to senior management, for business decisions.
Use tableau to create data visualization reports and analysis for Network Management.
Create regular reports as requested by regulatory department to report to NY DOH, and CMS.
A Bachelor’s degree from an accredited institution or at least 5 years of relative experience.
E xperience with SQL where you have created queries and performed data manipulations/analysis.
Experience in modeling financial impact of provider contract changes.
Analytical work experience within the healthcare industry specifically focusing on healthcare claims ( i.e. hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)
E xperience with MS Excel functions that include working with large data sets, creating standardized reports, utilizing v l ookups and advanced functions/ formulas; creating, using and interpreting pivot tables, filtering and formatting.
Self-motivated, creative problem solver who can work independently and collaborate through strong communication and interpersonal skills.
Knowledge of healthcare financial terms such as cost, utilization, Per Member Per Month (PMPM) and revenue.
Experience creating data visualization reports and analysis with Tableau.
Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other payment mechanisms.
Experience with Value Based Payment reporting and analysis.
Experience writing queries in Redshift, Python and/or R.
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