Independent Health

Financial Planning and Analysis

• Prepare check writes for self-funded medical, dental and reimbursement account business as assigned, to include review, documentation, verification and reconciliation of disbursement records for both manual (i.e., check) and electronic (EFT) payment processing.
• Investigate and analyze system documentation to ensure proper reporting of disbursements on behalf of self-funded clients, as assigned.
• Coordinate the corporate accounts payable process including receipt and coding of vendor invoices, preparation of supporting documentation and reporting, communication with parent company Accounts Payable personnel.
• Prepare customer invoices for self-funded medical, dental, reimbursement account business as assigned, to include review, documentation, verification and reconciliation of customer billing to accounts receivable collections.
• Investigate and analyze system documentation to ensure proper reporting of revenues for the business, as assigned.
• Monitor bank transactions for corporate and client bank accounts; performing daily cash reconciliations and coordinating shortages with appropriate channels.
• Update, develop and maintain summary reports for self-funded lines of business using system generated reports.
• Act as intermediary between functional groups within the finance department and across other departments.
• Independently research reporting discrepancies, suggest resolution and recommend process improvement.

Financial Operations Representative

General

• Adjudicate claims based on established policies and procedures for facility, professional, member submitted, pharmacy and dental claim edits.
• Review vouchers/explanation of payments to identify and resolve claims related issues.
• Continually meet department performance measures as it relates to production, accuracy, knowledge of policy and procedure and timeliness of claims adjudication.
• Analyze, identify and research, as needed, edits which demonstrate inconsistency in regard to policy, payment issues and coding issues.
• Maintain current contract, summary plan description and benefit knowledge.
• Ability to adhere to departmental deadlines and turn-around times, to be compliant with State and Federal regulations.
• Effectively utilize critical thinking skills to process claims.
• Efficiently navigate through systems and applications to locate information specific to claim scenarios.
• Accurately locate resources and read, interpret, and apply appropriate information to various claim scenarios.
• Identify and communicate process opportunities or improvements.
• Prioritize and manage claim processing workload in an efficient manner.
• Effective written, verbal and interpersonal communication with other departments within Independent Health to resolve problems related to claims payment.

Claims Adjudicator

• Implement and evaluate wellness programs to ensure that they are educational, outcome based and focus upon engaging the member/participant using employer based, medical claims and self-reported data to continuously adjust the plan to achieve targets
• Work with Wellness team on the development of new programs
• Coordinate programs and services with sales staff and brokers to meet the needs of targeted employer groups
• Align with Clinical Management, Quality Management, HR, Foundation, Sales/Marketing and other departments as needed to promote wellness and preventive care with employer groups and the community
• Maintain exemplary levels of customer service in accordance with IH Mission, Vision and Values
• Present wellness services in an engaging and professional manner
• Evaluate presentation outcomes and make recommendations to senior staff/management
• Develop strong relationships with internal and external representatives and link with community resources
• Service the needs of the Wellness department’s customers by being a resource for members and employer groups
• Coordinate all customer specific details associated with wellness initiatives and programs
• Analyze data to design, implement and evaluate customer specific wellness programs
• Support marketing and promotion of wellness programs to employer groups and the community
• Manage all administrative aspects for each program’s projects or processes and make recommendations on process changes or additions to the program to create efficiencies and cost savings.

Corporate Wellness Specialist

Security Engineer

• Supports security, safety and protection efforts for Independent Health associates, guests, visitors, members and properties
• Responsible for 24x7 monitoring, reporting and response associated with Physical Security initiatives
• Oversight of access controls, alarms, CCTV, and notification of events impacting physical security
• Daily monitoring of security cameras and campus site/buildings
• Physical security liaison to IHA & IHC associates
• Support of IHA & IHC departmental needs including escort
• Familiarity and response to campus emergency and security incidents/events including 911 calls
• Maintenance and preparation of daily reports, logs and incident reports as required
• Answer alarms and investigate disturbances
• Report unlawful activities such as theft or vandalism to law enforcement officers for further actions
• Coordinate with guard force to ensure daily reports, logs and incident reports are completed

Security Guard

Medical Director

• Responsible for assisting the Medical Director in the oversight of Utilization Management (UM) programs
• Support the development and maintenance of these programs, focusing on clinical accuracy and appropriateness
• Assist the Medical Director in developing strategic corporate direction for UM programs
• Support the SVP, Healthcare Services in preparing annual metrics of results for UM programs
• Contribute to measurable outcomes for prior authorization, step therapy, and quantity limit programs
• Collaborate with internal teams to support corporate HEDIS initiatives with appropriate clinical program development
• Work closely with clinical program development teams, clinical service operations, and clinical quality committees
• Provide clinical guidance and oversight to these areas
• Serve on IH committees as directed by the Medical Director

Associate Medical Director – UM PT

Manager

• Responsible for helping members achieve a level of well-being
• Perform telephonic outreach to members, physicians, or other care givers
• Develop a plan of care for the member who needs CM services
• Perform case management functions using a member-centric, collaborative process
• Apply assessment, planning, facilitation, care coordination, evaluation and advocacy
• Measure and report outcomes that demonstrate the efficacy, quality, and cost-effectiveness of case management interventions
• Facilitate communication and coordination between members of the healthcare team

Case Manager

Security Operations

• Supports security, safety and protection efforts for Independent Health associates, guests, visitors, members and properties
• Responsible for 24x7 monitoring, reporting and response associated with Physical Security initiatives at the main campus, affiliate, and Medicare Information Center locations
• Includes oversight of access controls, alarms, CCTV, and accurate and timely notification of events impacting physical security and/or facilities to the appropriate IH team member
• Daily monitoring of security cameras and campus site/buildings
• Physical security liaison to IHA & IHC associates
• Support of IHA & IHC departmental needs including escort
• Familiarity and response to campus emergency and security incidents/events including 911 calls
• Maintenance and preparation of daily reports, logs and incident reports as required
• Answer alarms and investigate disturbances, coordinating with Facilities managers as appropriate
• Report unlawful activities such as theft or vandalism to law enforcement officers for further actions
• Coordinate with guard force to include but not limited to, assessing; validating routine patrol rounds are conducted within the assigned premises; ensuring daily reports, logs and incident reports are completed by the security guard force