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Manager, Risk Score Accuracy

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Healthfirst

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Location:
United States , New York City

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Category:
Finance

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Contract Type:
Not provided

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Salary:

103400.00 - 149430.00 USD / Year
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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

Additional Information:

Job Posted:
December 09, 2025

Employment Type:
Fulltime
Work Type:
Hybrid work
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