Senior Analyst, Total Cost of Care

HealthFirst•New York, NY

7d•$83,100 - $120,360•Hybrid

About The Position

The Senior Analyst, Total Cost of Care develops analyses and tools to monitor financial performance and provide analytic insights across Healthfirst’s products. This role serves as a healthcare analytics and data subject matter expert, supporting medical trend, medical cost savings, provider network informatics, and reimbursement accuracy. The position is suited to a results-oriented professional with a managed care, medical economics, insurance, actuarial, or hospital background who can work in a fast-paced, challenging environment. The role follows a hybrid schedule and is onsite at 100 Church Street, New York, NY 10007, every Tuesday, Wednesday, and Thursday.

Requirements

Bachelor’s degree from an accredited institution.
At least three years of healthcare analytics experience, including at least two years in contract evaluation, medical economics, medical cost containment, actuarial work, or healthcare reimbursement model design.
Extensive knowledge of managed care financial metrics, including PMPM, utilization per thousand, and cost per unit.
Experience using healthcare claims data to identify insights that improve financial performance.
Experience with government and proprietary payer reimbursement methodologies and unit cost management.
Experience with SAS or SQL, including creating queries and manipulating data.
Extensive experience with Microsoft Excel, including building financial models and using pivot tables, VLOOKUPs, INDEX/MATCH, and calculated fields.
Claims experience, including root-cause analysis and system setup.
Ability to work with large data sets.
Strong written and verbal communication skills.
Resourcefulness and creativity in solving complex issues and collaborating with others on solutions.
Ability to manage projects and project plans within stated timelines.

Nice To Haves

Expertise in managed care concepts and provider reimbursement principles, including risk adjustment, capitation, fee-for-service, Diagnosis Related Groups (DRGs), Ambulatory Patient Groups (APGs), Ambulatory Payment Classifications (APCs), and other payment mechanisms.
Understanding of value-based risk arrangements.
Experience using Tableau and Python.
Experience mentoring other team members.

Responsibilities

Develop actionable analytic tools to monitor medical cost and utilization trends, identify root-cause drivers, and work with the team to develop remediation opportunities.
Develop savings analyses for Medical Economics cost-trend reduction initiatives, using financial modeling expertise and independent judgment to determine valuation methods.
Prioritize cost-mitigation activities across business areas.
Provide data-driven analysis to Finance, Claims, Pharmacy, Payment Integrity, Medical Management, Network, and other departments to support decision-making.
Evaluate data to identify and determine the root causes of payment integrity issues, and lead cross-functional problem-solving efforts.
Develop interactive financial models to evaluate the impact of provider reimbursement changes.
Support provider settlement and data reconciliation activities.
Stay informed about New York Medicaid and Medicare reforms and reimbursement methodologies, and assess their impact on Healthfirst and its owner hospital performance.
Perform ad hoc analyses.