Sr Analyst Risk Adjust

The Senior Healthcare Analyst will analyze internal and external data sources to generate insights, lead quality improvement projects based on those insights, and build ongoing reporting to monitor implementation success. You will support Healthfirst Risk Adjustment activities - an important source of revenue to care for our most at-risk members. This role is ideal for candidates interested in a career at the intersection of healthcare, finance, and data analysis.

  • Analyze large data sets to determine gaps or sources of inaccurate and incomplete data.
  • Work with vendors to develop member- and provider-facing strategies that improve data accuracy and enhance our understanding of the health of the populations we serve.
  • Create "buy-in" for new projects from internal stakeholders by calculating financial impacts or improved efficiencies tied to quality improvement initiatives.
  • Ensure the smooth operation of projects by developing and maintaining key performance indicators (KPIs). Identify problems based on KPIs and work with providers, vendors and internal stakeholders to resolve these.
  • Ensure compliance from vendors by validating data submissions and reconciling actual activity against projections.
  • Share reporting on project success with internal subject matter experts and external provider partners, including hospitals and community health centers.

Minimum Qualifications:
  • Bachelor's degree from an accredited institution.
  • Familiarity with public health insurance programs, including Medicare, Medicaid and/or the Affordable Care Act.
  • Experience with big data or statistical software packages such as SAS (Enterprise Guide or Base SAS), SQL or STATA.
  • Two to four years of experience in analytics or quality improvement in the healthcare industry (i.e. hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, pharmaceutical, behavioral health organization, etc.).
  • Ability to reconcile and analyze large data sets to extract key metrics and identify trends.
  • Ability to communicate effectively and collaborate with a wide variety of stakeholders.
  • Strong MS excel skills - ability to create complex formulas, manipulate pivot tables, etc.

Preferred Qualifications:
  • Health, Data or Finance-focused Master's degree (i.e. MPH, MPA, MBA, etc) from an accredited institution
  • Familiarity with federal and state Risk Adjustment programs.

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, national origin, age, genetic information, military or veteran status, sexual orientation, marital status 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.

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