Duties & Responsibilities:

• Provides cost and trend surveillance for all lines of business. Leads the analysis of all designated categories to understand the drivers of cost and utilization increases/decreases, by designated category and provider compared to designated budget.

• Collaborates with team members to identify, analyze and document the monitoring related costs and vendor oversight, including building and developing monthly and quarterly reports to monitor spend and utilization dashboards.

• Monitors and organizes all aspects of our vendor contracts with including capitation/admin system configuration. This includes but is not limited to validating invoices, audit support, claims and utilization reports as well as identifying and overseeing any needed areas of recoupment from vendor.

• Assists the team with monitoring the department budgets and confirming all business-related expenses

• Adopts best practices in documenting job related processes. Documents policies and procedures, job aids and workflows for the department

• Supports the validation of all department finance related regulatory reporting submitted by Healthfirst to State and Federal agencies

• Conducts and assists with ad-hoc analyses as needed by the designated team and other Healthfirst departments

• Additional duties as necessary

Minimum Qualifications:

• Bachelor's Degree from an accredited institution

Preferred Qualifications:

• Intermediate level of understanding how to use Business Intelligence/reporting tools Base SAS/SAS EG/Tableau/Aginity Workbench/SQL Server Management Studio

• Intermediate level of understanding how to use reporting and/or dashboarding as a means to analyze and measure performance

• Intermediate skill level with MS Excel/Access/Word/PowerPoint

• Experience working with delegated vendors and performing oversight/monitoring activities within a managed care health plan or Pharmacy Benefits Manager

• Excellent time management skills to handle multiple projects and manage shifting priorities

Compliance & Regulatory Responsibilities: Noted above

License/Certification: N/A

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, 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.