Sr Healthcare Analyst, Risk Adjustment | Hybrid NY

Description and Requirements

The Senior Healthcare Analyst, Risk Adjustment is responsible for monitoring risk adjustment performance, communicating financial results, and identifying areas of opportunity for Healthfirst and hospital senior management. This role contributes to a broad range of departmental initiatives, including evaluating performance trends, forecasting risk scores, and supporting internal reporting and analysis. The Senior Healthcare Analyst works closely with Finance and cross-functional partners to deliver meaningful insights that support informed decision-making. Key stakeholders include Actuarial, Medicare and State Products, and hospital and provider reporting and analytics teams. This position is well suited for an analytical, collaborative professional who is continuing to develop their expertise and thrives in a fast-paced, challenging environment.

Job Description

• Provide ad-hoc analytical support for Medicare initiatives, including evaluating risk adjustment impacts, emerging financial trends, and other drivers of plan and provider performance.
• Assist with the forecasting and budgeting of Medicare risk scores by analyzing historical and emerging trends, developing projections, evaluating key risk adjustment drivers, and assessing the resulting impact on revenue and financial performance.
• Cross-train on Medicare and Commercial accrual processes to provide backup support and strengthen understanding of monthly financial close and reporting activities.
• Develop and maintain Python/SQL-based processes used to calculate, validate, and analyze Medicare and Commercial accruals, with a focus on accuracy, reproducibility, and process efficiency.
• Partner with Finance, Actuarial, Network Management, and other stakeholders to investigate accrual variances, reconcile results, and explain key drivers of month-over-month changes.
• Summarize complex financial and operational data into clear, actionable insights and effectively communicate findings, key trends, and recommendations to stakeholders at various levels of the organization, including senior leadership and executive management.

• • Bachelor's degree or higher from an accredited institution with a concentration in Finance, Accounting, Business, Public Health, Healthcare Policy, or Healthcare Administration
  • 3+ years of related experience
  • 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.
  • Current or previous work experience in healthcare
  • Experience with analyzing medical cost and utilization trends
  • Knowledge of Medicaid and Medicare programs
  • Skills in Excel

• • Actuary experience and/or background
  • Experience in modeling financial impact of provider reimbursement changes
  • Skills in SAS, Python, R, Tableau, or a similar coding language
  • Experience in modeling financial impact of provider reimbursement changes