Full Time
I'm Interested

Job Type

Full Time

Job Details

Who we are:
Healthfirst was founded by a collection of major healthcare systems in the New York area to emphasize high quality of care, and better patient outcomes. We have grown into New York’s largest not-for-profit health insurer. Healthfirst accomplishes this all while following our value-based model and collaborating with our hospital sponsors and provider partners through our provider delivery system.

More about the team, and the role:
Transactional healthcare data is the lifeline for our value-based payment model. The Risk Adjustment & Encounters Reporting team is unique, as it relies on establishing workstreams and developing partnerships across the care continuum to ensure data accuracy and integrity prior to its submission to Centers for Medicare & Medicaid Services, and the New York State Department of Health.

As Program Manager, Risk Score Accuracy, you are operating a team which focuses on developing analytics and managing scaled vendor operations that will improve the accuracy of our member’s risk scores across our Medicare, Medicaid and Commercial Lines of business. 50% of the time will be development of analytics and reporting to align and optimize our vendor activities. 25% managing the relationships with the vendors, 25% managing a team of analysts dedicated to support all of the above.

You will be:

  • Developing analytics and reporting that will optimize the efforts of our contracted risk adjustment vendor and track measures to be shared amongst internal stakeholders on an ad-hoc and cadenced basis.
  • Effectively managing a team to support the Risk Score Accuracy programs by setting clear milestones and deliverables, clearly communicating goals, objectives and responsibilities, keeping them focused on terms of deliverable management and meeting targeted timeline.
  • Serving as the main point of contact for our vendors to support the day to day their day to day operations and ensure their assets are deployed appropriately to support our enterprise goals for Risk Score Accuracy
  • Acting as primary point person for delegated vendor oversight activities. This includes managing regular QA processes related to communications sent on Healthfirst's behalf to member and providers, as well as facilitating scheduled or ad hoc audits done by Healthfirst or other external experts. Develop and maintain Healthfirst policies and procedures related to vendor oversight
  • Communicate and build relationships with program expectations as well as Healthfirst and vendor stakeholders in a timely and clear fashion. Setting and continually managing program expectations with current team members and stakeholders both internal and external
  • Assisting in managing contract renewals or other contract negotiations. Support Legal, Finance, and relevant business areas to ensure a smooth negotiation and implementation process
  • Assisting in developing and managing the budget and product line allocations for vendor(s) on an annual basis; tracking expenses vs budget on a monthly basis

Minimum Qualifications:

  • Must have a Bachelor's degree from an accredited institution
  • Experience with Risk Adjustment Methodologies (CMS-HCC, HHS-HCC, CDPS, 3M CRG)  or Value based healthcare methodologies
  • Analytical work experience within the healthcare industry.  with competencies in SQL script development and expert proficiency in MS Excel (Pivot Tables, Advanced Formulas)
  • Able to present information to senior and executive leadership on the progress of activities related to risk score accuracy.
  • Accountable to executive sponsors for schedule, budget, and quality of all program elements
  • Able to provide project management for managing projects across multiple departments

Preferred Qualifications:

  • Prior experience within healthcare industry specifically supporting hospitals, vendor or, payer networks is a plus.
  • Development Experience in Data Visualization Platforms (I.e Tableau, Power BI)

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.

EEO Law Poster and Supplement

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): $108,300 - $156,485

  • All Other Locations (within approved locations): $95,300 - $141,780

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.

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Program Manager – Risk Score Accuracy
I'm Interested