The posting
The Manager, Total Cost of Care, will monitor financial performance and provide analytic insights into all products offered within the Healthfirst portfolio. This leader will serve as healthcare economics and analytics subject matter expert, across all areas of medical trend, medical cost savings, provider network informatics, and reimbursement accuracy. The ideal candidate will come from a managed care, medical economics, insurance, actuarial, or hospital background, and will be a results-oriented individual who enjoys working in a fast-paced and challenging environment.
Scope of Responsibilities:
- Monitor medical cost and utilization trends, provide concise actionable insight into the root cause drivers, and develop potential remediation opportunities.
- Develop savings analyses for Medical Economics cost trend reduction initiatives, applying financial modeling expertise and using independent judgement to determine best valuation methods.
- Prioritization of cost mitigation activities across business areas.
- Provide actionable data driven analysis to Finance, Claims, Pharmacy, Payment Integrity, Medical Management, Network, and other departments to enable critical decision making.
- Optimize contractual reimbursement terms and coding across agreements, systematically identifying reimbursement outliers. Assess and work with Network to standardize contractual terms and language across all provider agreements.
- Evaluate data to identify and root cause of payment integrity issues and lead cross-functional efforts to problem solve.
- Lead development of tools and processes for efficient operational and reimbursement management of hospitals and physician partners, including unit cost projections.
- Develop interactive financial models to evaluate the impact of provider reimbursement changes.
- Support all provider settlement and data reconciliation activities.
- Development of tools to define profitability dashboards by product.
- Keep abreast of New York Medicaid and Medicare reforms, reimbursement methodologies, and their impact on Healthfirst and their owner hospital performance.
- Individual contributor subject matter expert and/or managerial responsibilities.
- Perform ad hoc analyses.
Minimum Qualifications:
- Bachelor’s Degree from an accredited institution.
- At least six (6) years of healthcare analytics experience, with at least three (3) years of experience in contract evaluation, medical economics, medical cost containment, actuarial , healthcare reimbursement model design
- Extensive knowledge of managed care financial metrics (PMPM, util/k, cost/unit).
- Experience utilizing healthcare claims data to uncover valuable insights to improve financial performance.
- Experience with Government and proprietary payor reimbursement methodologies and unit cost management.
- Experience with SAS or SQL (creates queries and manipulation of data).
- Extensive experience with Microsoft Excel (building financial models, utilizing pivot tables, vlookups, index match, and calculated fields).
- Claims experience including root-cause analysis, system set-up, etc
- Ability to work with large data sets.
- Strong written and verbal communication skills.
- Experienced in leading a team of analysts.
- Resourceful and creative in solving complex issues and working corroboratively with others on a solution.
- Ability to manage projects and project plans within stated timelines.
Preferred Qualifications:
- Expertise in 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.
- Understanding of value-based risk arrangements.
- Experience using Tableau, Python
- Experience mentoring other team members.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.
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 [email protected] 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 HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC.
Know Your Rights
All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.
Hiring Range*:
- Greater New York City Area (NY, NJ, CT residents): $103,400 - $149,430
- All Other Locations (within approved locations): $88,700 - $131,920
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.
