Lead Risk Analyst

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Lead Risk Analyst will be responsible for the development and maintenance of various reports, dashboards and analytics focusing on plan financials/risk, value-based initiatives, contracting and regulatory requirements. The role will be one that fosters collaboration with intra-departmental and external partners to achieve company goals. This position will also serve to become a subject matter expert to the plan's financial operations, assisting in guiding staff on the most appropriate and accurate methods of reporting.

• Development maintenance and enhancement of financial reporting processes and dashboards spanning internal, regulatory, and external party initiatives.
• Assist with the reporting and evaluation of new or pre-existing risk and value-based payment (VBP) arrangements.
• Partner with actuaries to deliver supporting data and assist with inquiries as it pertains to corporate finances.
• Work with vendors and external customers to deliver accurate and meaningful data, predominantly focused on financials and related initiatives.
• Interpret and assist in implementing or adjusting processes to meet financial reporting requirements as it pertains to evolving NY State (MMCOR), CMS and HHS guidelines.
• Responsible for research collection, analysis and presentation of the Plan's utilization and financial data.
• Knowledge of and ability to report on NYSDOH (CRG), CMS (EDPS) and ACA (EDGE) risk systems and their impact to the plan.
• Reporting on financial and quality history as part of the assessment of provider contracts.
• Timely and accurate financial reporting as it pertains to operations that can also impact CMS Star ratings.
• Provide guidance, quality checks and general operational assistance to the Risk Analyst position.

• Bachelor's degree with 3+ years of experience industry related (business, health care, consulting, insurance, government)
• Insurance operations experience preferred
• Proficiency in Microsoft Excel, Access and Word are necessary.
• Intermediate to expert skills in SQL (Microsoft SQL)
• Experience with statistical systems and regulatory reports
• Experience with creating dashboards (Excel Power Query, Tableau, Power BI, etc...)
• Openness to leveraging new software platforms to achieve goals in an efficient manner.
• Familiarity with risk methodologies such as CRG (3M), CMS and HHS are a plus
• Experience with provider contracting a plus

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical Skills
• Written/Oral Communication

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