Manager, Risk Score Accuracy - Health First : Job Details

Duties:

• Develop and maintain risk score forecasting models to assist Actuarial in budget, quarterly forecasting and bid

• Manage revenue trend models and identify route cause of developing trends.

• Manage monthly analysis for analytical meetings discussing variances to budget.

• Manage all analytical audit requests as they relate to Medicare RADV and OIG and prepare financial impacts estimations.

• Respond to requests for analysis and provide analytic support to the Product managers and actuarial department.

• Pull data from the warehouse using Statistical Analysis System (SAS)/Structured Query Language (SQL) code and generate reports using SAS.

• 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 Medicare reforms and their impact on the health plan and owner hospital performance.

Minimum Requirements:

• Bachelors degree from an accredited institution.

• At least 5 years previous work experience within risk adjustment

• Credentialed Associate of the Society of Actuaries (ASA)

• 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 financial impact of risk revenue changes.

• Experience in supporting Product and Actuarial analytical requests.

• Experience with CMS/HHS risk adjustment payment methodologies.

• 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.

Preferred Qualifications:

• At least 7 years previous work experience within risk adjustment

• Data Visualization Experience (Tableau or Qlik View or Power BI).

• Python Scripting.

• 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

Location:

• Hybrid, NY (3 days on-site per week) 100 Church Street, NYC

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, 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.