Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.


To protect the health and safety of our workforce, members, patients, and the communities we serve, the EmblemHealth family of companies require all new employees to be fully vaccinated for COVID-19. Exemption/reasonable accommodations may be granted because of 1) a qualifying medical condition or disability that makes getting the vaccine unsafe for the individual, or 2) objection on the basis of sincerely held religious beliefs and/or practices.

Sr. Revenue Analyst

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Manager & Professional
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EmblemHealth
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Provides complex analytical and reporting/data mining support to the Enterprise Risk Adjustment Department for Medicare, Medicaid and HIX products. Performs data and analytical services in support of optimizing Enterprise risk adjusted revenue, maintaining compliance with CMS standards and modeling financial impacts of changes in risk adjustment data and methodologies. Must have strong Risk Adjustment experience/knowledge. Collaborates regularly with internal departments, including but not limited to, Finance, Medicare Operations, Network Management, Provider Contracting, and Health Economics, and external vendors on risk adjustment projects. Calculates ROI for risk adjustment vendors, initiatives and projects. Multitasks and prioritizes various tasks to meet deadlines. Understands various areas of the business and operational processes relevant to the project’s goals. Assists in performing analyses used in the development of financial plans, re-forecasts, and other financial projections. Works on identifying gaps in the claims, encounter reconciliation process, and provides insights to educate providers
Builds reports and dashboards to track risk adjustment related projects and track the effectiveness of the initiatives. Participates in special projects and performs related duties as assigned.

Responsibilities:

  • Prepares complex monthly revenue valuation analysis, identifying & attributing proper credit to all initiatives. 
  • Produces trends month by month, year over year and other complex reports & analyses.
  • Interacts with business teams to gather the requirements and translate technical language. 
  • Maps documents after the necessary data analysis.
  • Develop and maintain a sophisticated database where large volumes of data can be loaded, and information extracted for monthly dashboard reporting.
  • Ensures accuracy of all monthly & supplemental data feed extracts.   
  • Liaises with IT and vendors' management teams on data issues & findings.  
  • Delivers on timely basis.
  • Produce ad hoc reports as requested.
  • Develops programs extracting specific claims details to create request files to FFS groups for wrap-around data. 
  • Cleans & properly formats files, ready for EH Submissions team.

Qualifications:

  • Bachelor’s Degree in Finance, Health Care Management or related field
  • Minimum of three years of managed care insurance industry experience required
  • Minimum of three years of Medicare and/or Commercial Risk Adjustment methodology experience preferred
  • Experience in health care industry and knowledge of health care data, metrics and business concepts
  • Advanced Excel skills (formulas, pivot tables, Visual Basic) and advanced Access skills required
  • Intermediate coding skills required in SAS and/or SQL 
  • Tableau knowledge preferred
  • Minimum 4 - 6 yrs. experience with Information Management/Analysis within a Healthcare environment, preferably within the payer provider contracting or utilization management area (R)
  • Strong SAS, access and oracle database skills required  (R) 
  • An understanding of CPT, RBRVS, ICD codes and CMS-HCC Risk Adjustment Payment Methodology (R)

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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