Manager, Risk Score Accuracy

Positioned in the Finance Department, the Manager, Risk Score Accuracy will be responsible for risk score accuracy through developing and managing forecasting models to support budgets and quarterly forecasts and interface with various departments across the organization to ensure appropriate explanations of any material variances to expectations. This position requires an energetic, detail-oriented, and self-driven candidate who is adept at problem solving, possesses strong SQL coding skills, and an ability to communicate effectively with internal & external stakeholders.

Healthfirst was founded by a collection of major healthcare systems in the New York area to emphasize high quality of care, and better patient outcomes. We have grown into New York’s largest not-for-profit health insurer that covers members in New York City and on Long Island, as well as in Westchester, Sullivan, Orange, and Rockland counties. Healthfirst accomplishes this all while collaborating with our hospital sponsors, provider partners, and provider delivery system via our value-based model.

As Manager, Risk Score Accuracy – your role will be critical towards our efforts to understand the interplay between medical claims, clinical groupings and provider behavior. You will work closely with Healthfirst's clinical leaders to create successful metrics, track progress, and communicate results.

• Hybrid, NY (3 days on-site) – 100 Church Street, NYC

• The Manager, Risk Score Accuracy is responsible for managing risk score expectations, communicating project and financial results and identifying areas of opportunity for Healthfirst and hospital senior management. You will be the lead on a broad set of projects across the department.

• 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.

• 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 Postgre
  
  SQL, 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.

• 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

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