Healthcare Analyst - Network Analytics
- New York, NY
The Healthcare Analyst (HCA) provides support to the Network Analytics team and Medical Economics department by performing functions that enable stakeholders to make key decisions within the Network. The HCA will use provider, member and claims data to support various tasks to achieve business objectives. This position requires an individual with emerging skills in areas of Network and Healthcare. You must also be someone who enjoys working in a fast paced and challenging environment.
Duties & Responsibilities:
- Analyze medical claims data to support the network teams with a variety of provider related decisions.
- Conduct ad-hoc analyses as requested by the Finance, Network Management, Operations, Regulatory, Legal, and other departments and assist with the development and presentation of analytical data reports.
- Conduct claims settlement analyses to determine if claims were paid correctly.
- Create regular reports as requested by regulatory department to report to NY DOH, and CMS.
- Generate recurring reports to support payments to providers for patient center medical home.
- Use tableau to create data visualization reports and analysis for Network Management.
- A Bachelor's degree from an accredited institution or relative experience.
- Experience with MS Excel functions that include working with large data sets, creating standardized reports, utilizing vlookups and advanced functions/ formulas; creating, using and interpreting pivot tables, filtering and formatting.
- Self-motivated, creative problem solver who can work independently and collaborate through strong communication and interpersonal skills.
- Experience with SQL where you have created queries and performed data manipulations/analysis.
- Analytical work experience within the healthcare industry specifically focusing on healthcare claims (i.e. hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)
- Experience creating data visualization reports and analysis with Tableau.
- Basic understanding of Medicaid and Medicare programs or other healthcare plans.
- Knowledge of healthcare financial terms such as cost, utilization, Per Member Per Month (PMPM) and revenue.
- Experience in modeling financial impact of provider contract changes.
- 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 Payment Classifications (APC's), and other payment mechanisms.
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 careers@Healthfirst.org 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.
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