Sr Healthcare Analyst - Medical Economics

Positioned within the Medical Economics department, the Medical Cost team values, implements, and tracks initiatives aimed at producing savings and bending cost trends. The team is empowered with the resources it needs to produce results and deliver impactful business recommendations. As a Senior Medical Economics Analyst, you’ll map out and construct detailed analyses, confront challenging and unfamiliar subjects, and interface with stakeholders across all departments and lines of business. The conclusions you reach have the potential to improve and influence the organization, playing an essential part in our mission to provide members with affordable and accessible high-quality care. Each day you’ll tackle new and unique questions, learning and growing as you develop strategies, find solutions, and build innovative new approaches that support our goals and drive success.

As a Senior Healthcare Analyst within Medical Economics, you will manage projects from analysis to implementation and beyond, ensuring that results are achieved, and leadership is aware of the unique headwinds and tailwinds faced by any initiative. The ability to simplify complex scenarios into key takeaways is essential, as is the ability to explain and drill into any given detail behind the analyses you create. You’ll be expected to make independent decisions and support them under scrutiny. Potential areas of analysis include payment policy, utilization management, and value-based payment arrangements. The ideal candidate will be eager to learn, excited to grow, ready for a challenge, and able to thrive in a collaborative and collegial work environment.

This is a hybrid opportunity - work schedule consists of reporting to our office 3 days per week located at 100 Church Street, NYC.

Duties & Responsibilities:

• Value new medical cost initiatives, applying financial modeling expertise and using independent judgement to determine the best methods and approaches to calculate accurate estimates of program savings.

• Provide data driven analysis to Finance, Claims, Medical Management, Network, and other departments to enable critical decision making.

• Coordinate program implementation with initiative owners and establish controls to validate that changes have occurred.

• Thoroughly vet and perform due diligence on potential value-based arrangements to assess financial impact, ensure operational feasibility, and identify impact on existing programs.

• Identify favorable and unfavorable performance trends within medical cost initiatives, communicate trends to leadership, and recommend changes to initiative owners to improve performance.

• Perform complex return on investment 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.

Minimum Qualifications:

• Bachelor’s degree from an accredited institution.

• Analytical work experience within the healthcare industry (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)

• Work experience with SQL where you have created SQL queries, pulled large data sets, and performed data manipulations/analysis.

• Experience with MS Excel functions that include working with large data sets, creating standardized reports, utilizing VLOOKUP 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.

• Self-motivated, creative problem solver who can work independently and collaborate through strong communication and interpersonal skills.

Preferred Qualifications:

• Bachelor’s degree or higher from an accredited institution with a concentration in Finance, Accounting, Business, or Healthcare Administration.

• 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 Paymen