Manager, Risk Score Accuracy

Who we are:
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.
More about the team, and the role:

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.

Location:

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

Summary:

• 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.

You will:

• 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.

Minimum Requirements:

• 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 Qualifications:

• 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

WE ARE AN EQUAL OPPORTUNITY EMPLOYER.  HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services,  LLC.

Know Your Rights

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $103,400 - $149,430

• All Other Locations (within approved locations): $88,700 - $131,920

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.