IEHP

Data Analyst

• Lead the development, preparation and presentation of reports and analyses to support IEHP’s Hospital & Ancillary Relations quality improvement programs utilizing available analytical tools and quality improvement methods.
• Develop key studies and reports, data review, design and selection of performance metrics while working closely with internal and external business owners in support of quality standards, strategic goals, and initiatives for hospitals.
• Develop timely and accurate data mining techniques to apply to new or existing standardized and ad-hoc reports that ensure consistent conclusions to data analysis.
• Serve as Lead Analyst in the analysis, interpretation, and translation of complex data, issues, trends, and action plans as it relates to program development, quality studies (e.g., effectiveness studies, satisfaction studies) and department priorities.
• Collaborate with internal and external partners on methodology to ensure requirements and analysis standards are met.
• Ensure key studies and reports are delivered accurately, timely, meeting compliance requirements.
• Responsible for managing assigned projects and effectively communicating with the Hospital & Ancillary Relations leadership team if any project deadlines or other deliverables are at risk.
• Ensure continuous evaluation of trends related to quality measures, clinical and operational program performance.
• Develop reports, analyses, and other materials for Joint Operations Meetings (JOM) between the Health Plan and hospitals, other providers, or external stakeholders.
• Develop training materials, communications, and presentations for various levels of management depending on audience and deliverables.

Data Analyst II – Hospital & Ancillary Relations

Auditor

• Initiate and expand recovery opportunities through provided audit results, Provider calls, Third Party Liability and CCS eligible services.
• Audit payment errors that result in Provider refund checks to properly apply funds and determine the root cause.
• Communicate with and answer Provider inquiries and/or Provider Disputes regarding the reason for the refund request based upon claims processing guidelines, contractual agreements involving the use of established payment methodologies, Division of Financial Responsibility, and regulatory guidelines.
• Promote teamwork and maintain effective working relationships with others throughout the organization.
• Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Auditor – Provider Recovery

Claims Specialist

• Evaluating professional, high dollar and outpatient/inpatient institutional claims while determining coverage and payment levels
• Evaluating and resolving provider disputes & appeals, issuing resolution letters, and processing adjustment requests timely and accurately in accordance with standard procedures that ensure compliance with regulatory guidelines
• Payment adjustment projects and complex claims as assigned

Claims Specialist I – Provider Claims

• Review and process provider dispute resolutions according to state and federal designated timeframes.
• Research reported issues; adjust claims and determine the root cause of the dispute.
• Draft written responses to providers in a professional manner within required timelines.
• Independently review and price complex edits related to all claim types to determine the appropriate handling for each including payment or denial.
• Complete the required number of weekly reviews deemed appropriate for this position.
• Respond to provider inquiries regarding disputes that have been submitted.
• Maintain, track, and prioritize assigned caseload through IEHP’s provider dispute database to ensure timely completion.
• Maintain knowledge of claims procedures and all appropriate reference materials; participate in ongoing training as needed.
• Communicate with a variety of people, both verbally and in writing, to perform research, gather information related to the case that is under review.
• Recommend opportunities for improvement identified through the trending and analysis of all incoming PDRs.
• Coordinate with other departments as necessary to facilitate resolution of claim related issues.
• Identify and report claim related billing issues to various departments for provider education.
• Any other duties as required to ensure Health Plan operations are successful.
• Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance.

Financial Planning and Analysis

• Complete the month-end close in an accurate and timely manner including but not limited to preparing monthly journal entries, financial statement analyses, and balance sheet reconciliations in compliance with standards
• Partner in review and approval of journal entries, financial statement analyses, and balance sheet reconciliations of lower-level accountants
• Research technical accounting topics, prepare and publish whitepapers, and assist in the implementation of GASB pronouncements
• Process large financial data sets efficiently and effectively using advanced MS Excel, SQL, and/or MS Access
• Collaborate in the preparation of the monthly Board Report for the Board of Directors meeting
• Identify, research, and resolve complex accounting issues
• Perform complex ad-hoc analysis and projects independently, as needed and/or requested by leadership
• Continuous process improvement, standardization, and documentation of all responsibilities including policies, processes, procedures, workpapers, supporting schedules, reports, and related accounting and business activities
• Participate in the annual financial audit process
• Cross train on other Senior Accountants’ responsibilities for back up to avoid disruption in monthly process
• Work collaboratively across different teams to communicate and resolve issues and/or to complete responsibilities
• Gather, monitor, and analyze financial data, report and advise on accounting discrepancies, and utilize professional judgment in the performance of accounting and financial activities to support financial reporting and decisions
• Develop and maintain standard operating procedures (SOP) for all areas of responsibilities
• Update job knowledge by keeping current with financial regulations and accepted industry practices and completing professional development courses
• Any other duties as required ensuring Health Plan operations are successful

Accountant III – Financial Reporting

Data Engineer

• Design, develop and implement reliable and effective data solutions based on business requirements.
• Maintain process design artifacts like data flow diagrams, end user process maps and technical design documents.
• Find trends in data sets and develop algorithms to help make raw data more useful to IEHP.
• Create and maintain optimal data pipeline architecture that meet security standards.
• Identify, design, and implement internal process improvements: automating manual processes, optimizing data delivery, re-designing infrastructure for greater scalability.
• Develop best practices for database design and development activities.
• Create complex functions, scripts, and services to support the Data Services team.
• Ensure all data solutions meet company and performance requirements.
• Work under minimal supervision with wide latitude for independent judgment.
• Conduct code reviews.
• Direct and mentor some level I and II engineers.
• Serve as a subject matter expert in key business projects.
• Recommend improvements to existing Data Services processes as necessary.
• Provide detailed analysis of data issues; data mapping; and the process for automation and enhancement of data quality.
• Analyze and integrate new technologies with existing applications to improve the design and functionality of applications.
• Maintain proficient programming skills in REST web services, C#.NET, TSQL, XML, JSON, and other relevant languages and/or frameworks.
• Develop and automate solutions to consume data from multiple data sources, including external API.
• Program and modify code in languages like Java, Json, Python, and Spark to support and implement Data Warehouse solutions.
• Design and deploy enterprise-scale cloud infrastructure solutions.
• Research, analyze, recommend and select technical approaches for solving difficult and meaningful development and integration problems.
• Work closely with the Data and Engineering teams to design best in class Azure implementations.
• Clearly and regularly communicate with management, colleagues, and domain units.

Data Engineer III

Human Resources

• Perform a variety of administrative support duties such as conducting research, gathering data, preparing spreadsheets and other similar functions
• Assist in resolving business issues using systems and data
• Analyze, generate, and maintain records and other reference material necessary for departmental use
• Perform any other duties as required to ensure Health Plan operations and department business needs are successful

Human Resources Intern

Administration

IEHP Intern – Administration

Marketing

IEHP Intern, Marketing

• Design and develop data warehouse Extraction, Transformation and Loading (ETL) solutions using Microsoft SQL Server Integration Services (SSIS), Azure Data Factory, Synapse Analytics, Az Data Bricks, PySpark ETL.
• Develop and implement data collection processes in conjunction with the data warehouse.
• Source data from legacy systems supporting a centralized data warehouse and reporting platform.
• Develop technical solutions to meet the requirements for Data Warehouse, BI & Analytics.
• Work with Informaticists and Analysts to translate analytic requirements into technical solutions.
• Collaborate and contribute to data integration strategies and visions.
• Create and maintain optimal data pipeline architectures based on micro services based on platform and application requirements.
• Work closely with the Data Engineering team, BI & Analytics team, Data Warehouse Architect, and Data Systems Architect to design data and analytics solutions to increase the usability, completeness, and accuracy of enterprise data.
• Work with stakeholders including the Executive, Product, Data and Design teams to assist with data-related technical issues and support their data infrastructure needs.
• Analyze user requirements and translate user requirements into database requirements and implement them in database code.
• Provide detailed analysis of data issues, data mapping, and the process for automation and enhancement of data quality.
• Assemble large, complex data sets that meet functional / non-functional business requirements.
• Identify, design, and implement process improvements: automating manual pipeline processes, optimizing data ingestion and consumption, re-designing infrastructure for greater scalability, micro services, and others as applicable.
• Create, maintain, and optimize SQL queries and routines.
• Analyze potential data quality issues to determine the root cause and create effective solutions.
• Develop, adopt, and enforce Data Warehouse and ETL standards and architecture.
• Monitor and support ETL processes ensuring integrity and proper integration of all data sources.
• Facilitate problem management and communication among data architects, managers, informaticists and analysts.
• Perform development activities such as source to target mapping validations, identify, document and execute unit test cases/scripts, peer and lead code reviews per code review checklist and document test and review results.
• Provide ongoing proactive technical support for ETL and data warehouse system to ensure business continuity.
• Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Data Engineer II

Director

• Find joy in serving others with IEHP!
• Provide strategic leadership and oversight for all Payment Integrity functions, ensuring payment accuracy, regulatory compliance, and cost containment.
• Develop and drive the vision and strategy for payment integrity programs and operational excellence.
• Partner across the enterprise to optimize reimbursement, prevent fraud, waste, abuse, and improve member affordability.
• Ensure the financial sustainability and regulatory compliance of the organization by preventing, identifying, and recovering inappropriate healthcare payments across all lines of business.

Director, Payment Integrity

IT Support

• Deliver exceptional Tier 1 and occasional Tier 2 technical support to ensure a seamless end-user experience
• Diagnose, research, and resolve routine technical issues across hardware, software, applications, systems, and access management
• Respond to support requests via phone, email, walk-up, and online channels
• Leverage enterprise tools to document, track, and monitor resolutions
• Contribute to data-driven initiatives, including some administration of enterprise applications
• Assist with preparation of accurate & timely reports
• Provide actionable insights to leadership

IT Specialist

• Troubleshoot complex production incidents affecting endpoints, collaboration tools, identity/access, and business applications.
• Work with ITSM team to identify root-cause analysis and implement corrective/preventive actions (RCA/CPA) as needed.
• Serve as an escalation point for Service Desk IT Specialist I.
• Participate in bridge calls as needed and coordinate with application, network, and security teams during major incidents.
• Provide remote support across Windows/macOS, M365 (Teams, Outlook, SharePoint, OneDrive), identity (Azure AD/Entra ID), and enterprise applications.
• Create and maintain runbooks, SOPs, and knowledge base (KB) articles to improve first-contact resolution and reduce MTTR.
• Backfill Service Desk queues during spikes or outages; ensure adherence to intake, triage, and escalation standards.
• Monitor ticket volumes, aging, and Service Level Agreements (SLA) performance; proactively remediate backlogs.
• Engage third-party vendors and carriers to resolve hardware failures, logistics issues, and connectivity/service problems as needed.
• Administer enterprise applications (including IEHP-specific systems, if applicable); manage configurations, access, and data integrity checks.
• Enforce endpoint hardening baselines, encryption, antivirus/EDR (Defender), and vulnerability remediation timelines.
• Write clear, user-friendly KBs and service guides; coach Tier 1 staff to improve first-contact resolution.
• Identify process gaps; propose and implement improvements to intake, triage, and escalation.

IT Specialist II

Manager

• Leading the daily operations of the Potential Quality Incident/Provider Preventable Condition and clinical reporting nurse teams.
• Ensure the complete review of Quality-of-Care cases, adherence to standard work, reporting accuracy, and compliance with IEHP policies, Local, State, and Federal laws, and regulations.
• The planning and implementation of any quality audit initiatives, programs, and processes identified by IEHP’s Quality System.
• Responsible for managing direct reports to ensure effective resource management and prioritization of work in support of meeting Quality and Organizational goals and priorities.
• Responsible for the development, management, implementation, and evaluation of all areas of responsibility including, but not limited to, Potential Quality Incidents (PQI)/Provider Preventable Conditions (PPC) processes, Quality Reviews, and clinical audits of IEHP Providers to ensure clinically appropriate billing.
• Provide oversight and management of the PQI and PPC processes and staff to comply with IEHP policies, Local, State, and Federal standards, and regulations.
• Collaborate with appropriate internal and external departments, team members, and entities to achieve organizational quality initiatives, as assigned.
• Responsible for the development, maintenance, implementation, and adherence to departmental policies and procedures, standard operating procedures, and job aides.
• Participate in Quality Management activities and projects to ensure interventions meet project goals.
• Lead, prepare, and coordinate appropriate Provider Quality Review department related internal meetings.
• Represent IEHP in external meeting related to key areas of responsibility as appropriate.
• Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP’s policies and procedures relating to HIPAA compliance.

Manager, Provider Quality Oversight

• Ensure appropriate resources and budget allocations, project planning completion, project intake, oversight, collaborative sprint and scrum management, and agile methodology application to the IT Project Portfolio.
• Mentor, coach and lead all Program and Project Managers.
• Ensure project Dashboard (Planview) and ADO standards are maintained and project data is available in near real time for leader status review and EPR portfolio presentation.
• Manage project/program managers and project teams with effective communication and coordination.
• Lead retro analysis of project practices and team practices, define and implement continuous improvements to increase the velocity and quality of IT Agile processes for maximum productivity.
• Manage project conflicts, challenges, and dynamic business requirements to keep operations running at a high performance.
• Work with the team leads to resolve problems and project roadblocks.
• Support product owner(s) with intra-team dynamics with respect to priorities and scope.
• Maintain team data resources and hours allocations in project management software to support estimates and execution.
• Lead retro analysis of project practices and team practices, define and implement continuous improvements to increase the velocity and quality of IT Agile processes for maximum productivity.
• Support product owner(s) with intra-team dynamics with respect to priorities and scope.
• Manage Project Progress, Acceptance and Project Transitions.
• Manage vendors and contractors on assigned engagements.
• Manage other special projects as assigned.
• Manage large organizational change management functions to address key projects assigned.
• Hire, train, and manage support staff, while monitoring and evaluating outcomes.
• Conduct performance reviews of each team Member within IEHP guidelines.
• Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Data Analyst II – Hospital & Ancillary Relations

Auditor – Provider Recovery

Claims Specialist I – Provider Claims

Claims Specialist I – Provider Claims

Accountant III – Financial Reporting

Data Engineer III

Human Resources Intern

IEHP Intern – Administration

IEHP Intern, Marketing

Data Engineer II

Director, Payment Integrity

IT Specialist

IT Specialist II

Manager, Provider Quality Oversight

IT PMO Manager