Healthcare Analyst - Medicare Risk Adjustment, New York, NY

Created 07/28/2021
Reference 1093718
Job type Full Time
State NY
City New York
Hello! Thank you for considering Healthfirst for your next career opportunity.

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 over 1.7 million 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 the Healthcare Analyst in Encounters Reporting team, you will be serving a critical role by performing data and analytical services in support of optimizing risk adjusted revenue and providing insights related to risk adjustment to different levels of leadership to support their decision-making.

You will be:
  • Assisting in maintenance and update of CMS-HCC software script in SAS/SQL to accurately calculate risk score and revenue accrual according to the CMS Risk model.
  • Developing Medicare Risk adjustment related reports to capture members' chronic conditions and monitor retrospective and prospective HCC gaps.
  • Performing data mining of claims to identify trends or data issues and translating that into financial impact.
  • Submitting and reconciling data from vendors/hospitals to maximize acceptance rate and revenue opportunities. Interface within the team to improve and correct the data.
  • Preparing data and reports for various dashboards that present members' historic disease information to help Healthfirst providers capture any missing HCCs.
  • Collaborating with internal and external stakeholders on risk adjustment related analyses and audits and sharing knowledge on industry updates.

At Minimum you should have:
  • A Bachelor's degree from an accredited institution
  • Excellent analytical and problem-solving abilities
  • Proficiency in SAS or SQL
  • Proficiency in Advanced Excel (Pivot Tables using Data model, Complex formula construction)
  • The ability to communicate effectively across multiple functional areas within an organization

Our Preferred Qualifications
  • A Bachelor's or Master's degree in Health Informatics, Statistics or Healthcare Finance
  • Previous work experience within the Healthcare Industry with risk adjustment or Analytics
  • Experience with CMS-HCC risk adjustment model including risk score and revenue accrual calculation

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability 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 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.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid "" 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, 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.
Employer Healthfirst Inc.

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