Sr. Healthcare Analyst, Medicare

The Senior Healthcare Analyst will support the department and work cross functionally with several departments in the organization on initiatives that enable key business processes in revenue maximization and risk adjustment. This position requires an individual with a strong technical background with an interest in Data, Finance and Healthcare. The ideal candidate will be someone who enjoys working in a team-oriented environment that is fast-paced and challenging.

  • Support Finance in developing forecasts and analytics using Medicare HCC models to accurately accrue and optimize risk adjustment revenue.
  • Develop Actionable Reporting to optimize the efficacy of vendor relationships.
  • Take ownership of cross departmental relationships to enhance collaboration on risk adjustment initiatives.
  • Reconcile between large data sources and research/correct discrepancies.
  • Assist, train and educate team members on data acquisition, transformation, and presentation.

Minimum Qualifications:
  • Proficiency with risk adjustment models (i.e HCC, ACA -HCC, CRG Groupers) as they pertain to reimbursement.
  • Work experience with SAS and/or SQL where you have created complex queries, pulled large data sets, performed data manipulations/analysis, performed direct programming functions.
  • Ability to reconcile and analyze large data sets and assist in the documentation of processes for change control purposes.
  • Bachelor's degree from an accredited institution. Practical experience, healthcare industry knowledge and technical expertise may be considered in lieu of a Bachelor's degree.
  • Ability to communicate effectively, and work well in a team oriented environment.

Preferred Qualifications:
  • Bachelor's degree or higher from an accredited institution with a concentration in Actuary, Economics, Mathematics, Statistics or Healthcare Administration.
  • 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, pharmaceutical, behavioral health organization, etc.).
  • Experience with encounter data/submissions and risk adjustment.
  • Work experience with Visual Basic for Applications (VBA).
  • Understanding of Medicaid and Medicare 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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