Senior Manager, Fee Schedules, Total Cost of Care

The Senior Manager, Fee Schedules, Total Cost of Care, will develop analyses and tools to help monitor financial performance and provide analytic insights into all products offered within the Healthfirst portfolio.

This key role will serve as healthcare analytics and data subject matter expert, supporting 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:

• Evaluate the financial impact of changes in CMS and NY State published fee schedules, applying financial modeling expertise and using independent judgement to determine best valuation methods.

• Understand and describe applicability of government fee schedule changes to provider reimbursement within the HF reimbursement model.

• Evaluation of reimbursement changes by provider group within the unit cost management workflows.

• Provide actionable data driven analysis to Finance, Claims, Pharmacy, Payment Integrity, Medical Management, Network, and other departments to enable critical decision making.

• Evaluate data to identify and root cause of fee schedule related payment integrity issues and lead cross-functional efforts to problem-solve.

• Develop interactive financial models to evaluate the impact of provider reimbursement changes.

• Keep abreast of New York Medicaid and Medicare reforms, reimbursement methodologies, and their impact on Healthfirst and their owner hospital performance.

• Perform ad hoc analyses.

Minimum Qualifications:  

• Bachelor’s Degree from an accredited institution.

• At least three (3) years of healthcare analytics experience, with at least two (2) 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.

• Expert in Government fee schedules 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.

• 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): $122,900 - $188,020

• All Other Locations (within approved locations): $105,100 - $160,480

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.