The Healthcare Economics Analyst (HEA) provides support to the Medical Economics team within Finance through the research and investigation of business issues related to cost, utilization and revenue data for multiple Healthfirst products. The HEA will identify/monitor cost and utilization trends and the root causes in health plan trend performance and provide recommendations for solutions.
Duties & Responsibilities:
- Provide analytical support for the Claims, Ancillary, Medical Management and Provider Network departments.
- Analyze the financial performance of all Healthfirst products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to management.
- Create financial models to evaluate the impact of provider reimbursement changes.
- Gather data and conduct ad-hoc analyses as directed by other Finance Analysis team members and assist with the development and presentation of analytical data reports.
- Support Financial Analysis projects related to medical cost reduction initiatives.
- Support Medical Management by assisting with Return on Investment (ROI) 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.
- Must have a Bachelor’s degree from an accredited institution majoring in Math, Finance or Actuarial Science
- Must have 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.)
- Must have proven work experience with SAS and/or SQL where you have created queries, pulled large data sets and performed data manipulations/analysis.
- Must have experience with MS Excel functions that include working with large data sets, creating standardized reports, utilizing vLookups 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.
- Experience in modeling financial impact of provider reimbursement changes.
- 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.
- 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.
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, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
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 Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
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