Manager, Risk Score Accuracy Job at Healthfirst (New York City)

Job Description

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.

Job Responsibility

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

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

Nice to have

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

What we offer

Medical, dental and vision coverage
Incentive and recognition programs
Life insurance
401k contributions

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Manager, Risk Score Accuracy

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