Independent Health

Learning and Development

• Responsible for the development and execution of onboarding and training initiatives
• Creation, delivery, and documentation of onboarding training and annual training
• Work with associates from all levels to determine department-specific training needs
• Leverage training to support workforce in technical and operational needs
• Develop, deliver, refine, and communicate all training and new hire curriculums
• Schedule and communicate new hire training
• Develop and deliver annual compliance and accreditation training
• Coordinate training activities and ensure documentation of training is complete
• Assist in development and delivery of training based on new requirements

Training Specialist

Accounting Manager

• Assist with the development, execution, and supervision of all operational and reporting responsibilities of the Accounting and Tax department
• Preparation and review of the monthly, quarterly, and annual financial GAAP and statutory financial statements
• Provide support to ensure the timely and accurate filing of all quarterly and annual tax and regulatory submissions
• Assist in the development and training of the tax and accounting team
• Ensure timely completion of department and company objectives and priorities
• Monitor and maintain compliance with accounting and company policies, procedures, and internal controls
• Lead and/or participate in cross functional teams throughout the organization
• Support other departments in the Strategic Initiatives

Tax Accounting Manager

Account Executive

• Responsible for meeting sales productivity goals set by the Reliance Rx Leadership team
• Maintain extensive records of prospects
• Attend national sales conferences and conventions
• Attend community events
• Build relationships and conduct meetings with physicians, brokers, and high-level manufacturer and payer executives
• Analyze potential client issues and needs and provide solutions to meet or exceed expectations
• Provide weekly agendas and call/visit logs for regularly scheduled meetings with Reliance Rx Leadership

Regional Sales Executive

Solutions Engineer

• Guide other Architects in the definition, design, enhancement, and solution delivery of the TIBCO application and troubleshooting integration issues
• Evaluate and provide technical solution recommendations to meet enterprise-wide business requirements
• Work with the Application Development Manager, to develop team goals and objectives to support corporate goals
• Provide day-to-day technical support to Solution Architects, Application Developers, and other IT resources to solve problems
• Create reusability into systems for other IT resources to utilize in their development efforts by creating solutions using microservice architecture and RESTful APIs

Lead Solution Architect – Tibco

Manager

• Responsible for helping members achieve a level of well-being through quality improvement functions
• Perform telephonic outreach to develop a plan of care for members who need CM services
• Apply guiding principles for case management practice to include assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services
• Adhere to regulatory and compliance requirements, department productivity and quality metrics, and provide exceptional customer service

Case Manager

Medical Reviewer

• responsible for the collection and review of medical records specific to quality complaints/grievances and appeals as indicated in support of a high performing health plan and physician network
• investigate quality complaints/grievances and appeals
• document research of initial coverage determinations
• lead coordination of clinical review with appropriate internal stakeholders and Medical Director
• prepare written responses to appeals and complaints/grievances
• establish plans of correction and provide education to members and providers
• initiate ancillary department referrals in accordance with regulatory standards, clinical criteria, and member benefit contract

Clinical Reviewer

Analyst

• Acts as a liaison between internal teams to ensure accurate and complete data reporting
• Develops standard operating procedures (SOPs) for existing and new reports
• Works collaboratively with other data team professionals to meet business and customer deadlines
• Independently performs and documents reviews of data projects for completeness, accuracy, and adherence to business requirements
• Responsible for performing quality verification tasks and ensuring the accuracy of reported data
• Applies analytical and problem-solving skills to the design, planning, execution, and deployment of assigned projects
• Determines best practice approach for audit, validation, redevelopment, and usefulness of assigned data sets and reports
• Implements SOP to investigate issues and coordinate efforts between the end user and related departments and external agencies to correct data discrepancies

Data Validation Analyst

Accounts Payable

• Timely and accurate posting of all cash receipts (lockbox, physical checks and 835s)
• Review reconciliation of daily cash receipts to bank/system reports
• Review proof/posts, ensure accurate general ledger account posting
• Coordinate with accounting and billing teams when necessary
• Ensure differences are researched and reconciled timely to obtain 100% accuracy
• Prepare/review monthly cash receipts close schedules and entries
• Coordinate with the account team to ensure differences do not exist
• Assist the accounting team and immediate supervisor with monthly/annual schedules as needed
• Assist with internal/external requests in a timely manner
• Act as lead in the cross training of other department members as it relates to cash receipts
• Develop and update documentation of procedures for department procedure manual
• Process, code and submit all vendor invoices in a timely matter
• Ensure accuracy of all vendor invoices using purchase orders or verify charges with the appropriate member of the leadership team
• Act as the Reliance Rx point of contact for all vendor relationships relating to the accounts payable function
• Timely processing of all expense reports for the Reliance Rx leadership team and other staff as time permits
• Ensure all invoices received at month-end are provided to the accounting team on a timely basis for month-end close accrual entries

Cash and Accounts Payable Coordinator

• Develop and maintain the department’s call center goals as defined by senior management
• Enhance member and provider relationships by increasing satisfaction through leadership of the Pharmacy Help Desk and Member Services teams
• Promote teamwork and accountability in a performance based work environment
• Hire, train, mentor, and evaluate staff; manage personnel issues
• Monitor workflow, identify process improvement, and implement system changes
• Be accountable for overall quality, performance, customer satisfaction and financial goals for the servicing department
• Support and oversee supervisors and specialists and corporate initiatives
• Work closely with operations, support services and HR to ensure staffing, quality delivery, and staff development
• Oversee daily attendance, productivity, and quality standards for team members
• Maintain high levels of internal and external customer satisfaction and drive first-call resolution
• Monitor performance metrics and adjust assignments to meet service level goals
• Ensure adequate coverage through scheduling oversight and workload management
• Manage departmental budget and proactively address operational challenges using data insights
• Maintain up-to-date knowledge of contracts, benefits, and internal systems and ensure HIPAA compliance through regular monitoring and auditing of team communications

Manager – Provider and Member Services

Billing Specialist

• Responsible for billing all claims (pharmacy and medical) and managing rejections to ensure appropriate follow up and delivery promise times are met
• Act as a liaison between patients and insurance companies, and facilitate communication between patients and doctors, medical staff and administrative staff
• Work with payors to resolve any billing issues
• Ensure Reliance Rx is following CMS guidelines per Medicare and Medicaid guidance
• Confirmation of billing accuracy and payor billing/shipping requirements
• Process and set up deliveries to medical offices
• Medical claims billing for both supplies and medications
• Confirm financial aspects of the claims prior to them leaving the facility
• Portal management including refill reminders, processing orders from the portal, and completing patient registrations
• Financial assistance coordination with patients for foundation care, copay assistance, or free medication programs where applicable
• Assist the Patient Care Specialists in workflow and with incoming and outgoing calls, maintaining patient records, filing and documentation duties
• Set up and data entry, financial arrangements and collecting co-payments
• Prior authorization assistance with offices and coordination of benefits
• Promote information sharing and continuous process improvement
• Function in strict accordance with standard, written procedures and guidelines with deviation approved by the supervising pharmacist

Billing Specialist, Pharmacy Technician

Customer Support

• Display confidence, practice empathetic listening, and connect with Independent Health members
• Actively listen, assess needs, and utilize system tools and resources to address and resolve inquiries
• Make appropriate process or regulatory determinations and follow escalation procedures as needed
• Research complex issues pertaining to benefits, claims, plans, and eligibility across multiple databases
• Confidently navigate multiple computer systems and toggle between screens while engaging with members
• Document all calls accurately and timely, escalate issues per policy, and meet quality/productivity goals
• Maintain technical knowledge of contracts and benefits; attend required training sessions
• Use multiple systems for Claims, Enrollment, Authorizations, Finance, Accounts Receivable, Provider and Reference screens
• Determine claim status, adjudication correctness, and make claim adjustments using established criteria

Customer Service Representative

Software Engineer

• Lead cloud data architecture and integration initiatives by designing and implementing enterprise data pipelines and architectures connecting Microsoft Dynamics CRM, Microsoft Dataverse, Azure Synapse, and other platforms.
• Apply advanced SQL and data engineering techniques to ensure efficient data ingestion, transformation, and storage.
• Support the Azure and Power Platform Development by leading the build and optimize solutions using Azure Synapse Pipelines, Power BI (including semantic models and paginated reports), and Microsoft Dataverse.
• Seek methods to leverage Azure Data Factory, Azure DevOps, and CI/CD pipelines to enable scalable, automated data processes across integrated platforms.
• Collaborate with the organization’s information risk organization (IRO) and IT infrastructure teams to ensure all data solutions adhere to ITIL standards and organizational security compliance requirements.
• Develop solutions to monitor fine-tune query and pipeline performance within Synapse Dataverse and SQL-based systems and implement practices to reduce data latency and ensure reliability of business intelligence solutions.
• Provide technical leadership by guiding and mentoring IT associates. Champion software engineering standards, promote code quality, and lead technical project efforts.
• Stay current with cloud and data trends, especially within the Microsoft ecosystem. Recommend and implement improvements to tools, processes, and technologies that enhance enterprise data capabilities.
• Provide project leadership by translating complex business requirements into technical deliverables and leading cross-functional collaboration.
• Manage timelines, risks, and resource coordination for cloud data initiatives involving Azure, Dynamics CRM, and Dataverse.

Senior Cloud Data Developer

• The Behavioral Health Case Manager is primarily responsible for managing behavioral health benefits through the administration of quality improvement functions
• Develop a plan of care for identified population along the continuum of care within the scope of case management and accreditation standards
• Screen and assess member needs; develop person-centered care plans with goals
• Monitor and evaluate care plan effectiveness and modify as needed
• Coordinate with internal and external resources; collaborate with providers and community agencies
• Assist with hospital/facility discharge planning to coordinate post-inpatient BH treatment continuity
• Collaborate with Medical UM, Medical Case Management, and SIU for BH case reviews, product/benefit development, claims, and network activities
• Review policies, SOPs, reports and data related to BH CM programs
• Assist with annual program evaluations and work plans for BH CM programs
• Support quality improvement activities through data collection, measurement, reporting, evaluation and evidence-based intervention development for BH benefits and BH providers
• Participate in identification, analysis and evaluation of CM program outcomes; recommend interventions and implement improvements
• Attend meetings; establish professional relationships with Independent Health Associates

Behavioral Health Case Manager

IT Support

• The Pharmacy Help Desk Representative will be responsible for providing assistance to our pharmacies as well as internal servicing representatives in addressing and resolving pharmacy issues regarding reimbursement, proper utilization of policies and procedures and coordinating resolution to streamline the process through pharmacy education. These individuals must maintain our goals in achieving service levels and increasing the pharmacist satisfaction rate, the pharmacy help desk representative will function as a pharmacy advocate. This position will also assist with the entry of prior authorizations and other projects and assignments to support the pharmacy department. This position will assist with the training of new pharmacy help desk representatives and will act as a back up to member services phone lines. Occasional holidays, weekends, overtime, and on-call responsibilities are a requirement of the position.

• Essential Accountabilities A. Customer Servicing: Answer all types of provider phone calls and written correspondence in a timely fashion, with minimal supervision by a manager. Ensure that providers are obtaining accurate and up-to-date information on policies and procedures and communicate a successful resolution to inquiries. All calls to be logged into call documentation systems. Answer and document inquiries by internal customers including, but not limited to our servicing representatives and sales representatives. Answer member services calls as needed and document appropriately. Responsible for being logged in and ready to take calls at the start time of shift. Exercise a courteous, efficient, respectful, and timely response to all internal and external customers. Attend customer service training sessions and additional pharmacy system training as needed. “On-call” responsibilities on a rotating basis. In addition to assisting PBD departments with employee training, will assist with check and voucher questions and special projects as needed.

B. Technical Proficiency: Maintain technical knowledge regarding Independent Health and PBD pharmacy contracts and benefits and working knowledge of policies and procedures and department lists; and maintain updates on a daily basis. Assist in interpreting database information as it relates to pharmacy claims processing. Assist with PBM implementation by identifying potential issues and entering prior authorizations to reduce/avoid disruption and ensure smooth transition for new PBM plans/members. Assist the Pharmacy systems department with various data entry projects/information as they relate to pharmacy claims processing. C. Administrative Duties: Provide accurate and up-to-date information to all pharmacy providers by documenting pertinent information into Siebel; assist other departments in responding to questions from any pharmacy department mailing. Assist with preparation (triaging), logging in and logging out of authorization requests during evening and weekend shifts. Assist authorization area of the pharmacy department during the day, if needed. Immigration or work visa sponsorship will not be provided for this position Hiring Compensation Range: $19.00 hourly Compensation may vary based on factors including but not limited to skills, education, location and experience. In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future. As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information. Current Associates must apply internally via the Job Hub app. The Independent Health Family of Companies, headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, our comprehensive portfolio includes Pharmacy Benefit Dimensions, Reliance Rx, Nova Healthcare Administrators, Care for You and the Independent Health Foundation. Our culture sets us apart. Our core values drive who we are and the work we do. As a member of our family, you’re part of something special, in your work and in the community. We understand and appreciate that everyone has unique experiences, perspectives and identities which is why we pledge to create a safe space where all people and ideas are welcomed. We are here to continue learning and to generate important dialog. We are committed to doing what matters most - reaching out, working together, and caring for our community. A healthy community benefits everyone who lives in it. You too can be part of making difference in the lives of others, together we achieve so much more. Please click here to view our Community Reports. Apply today and join us on the journey to a happier, healthier, and more inclusive community. We are committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans. An applicant for employment in need of an accommodation to participate in the application and recruitment process should contact Human Resources at: accommodations@independenthealth.com or Human Resources, 511 Farber Lakes Drive, Williamsville, NY 14221. Please note, we do not accept unsolicited resumes. We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.

Pharmacy Help Desk Representative

The Provider Contracting & Reimbursement Analyst-Intermediate will analyze utilization, claims, membership, and cost data in support of Network Contract Management department and corporate strategic initiatives. The incumbent will be responsible for designing and using analytical tools, drawing statistically sound conclusions, and presenting results to management. The Analyst will interpret, analyze, and recommend courses of action to management as it relates to fair, equitable, and market competitive reimbursement designed to achieve value for the health plan, provider partners, and members. This individual will be responsible for designing and conducting analyses by applying independent judgment (e.g., making assumptions and identifying constraints of analyses), interpreting results, and making recommendations to management as it relates to assessing the impact of changes in reimbursement and representing hundreds of millions of dollars in annual expenditure. Analysis and research will be designed to support provider contract negotiations, assess the impact of potential alternative reimbursement models, improve Independent Health’s ability to deliver high quality, high value care, provide management with the ability to assess the impact of policy changes, government mandates, consolidations and mergers in the provider community.