Independent Health

Analyst

• Responsible for administration of the rebates process to include analysis, pricing, and optimization of processes to best implement and maximize contracts and amendments
• Support development of PBM rebate proposals, renewals, pricing, utilization metrics and analysis reports
• Manage, support and optimize analysis, pricing for contracts, RFPs and related processes
• Analyze contract language and financial parameters to maximize profit and evaluate business risk and ensure compliance

Rebates Analyst

Business Analyst

• Collaborate with stakeholders to elicit, develop, analyze, and validate business and technical requirements
• Liaison between IT and business stakeholders
• Develop and execute quality assurance test plans
• Lead business definition and process development of enterprise projects
• Work with Business Teams and project sub-teams to meet project requirements
• Utilize SQL to build technical specifications and analyze test results
• Develop integrated Test Plans and detail design solutions
• Ensure successful project execution and provide applications management support

IT Business Analyst

QA Engineer

• Conducting cross-environment validation between QA, UAT, and production, adhering to established Enterprise Quality Assurance Plan and providing feedback and suggestions on improvements
• Writing and executing complex SQL queries to perform data validation, reconciliation, and comparison of large datasets across environments
• Adhere to established EDW and ETL SDLC and Corrective Action guidelines and provide feedback and suggestions for improvements
• Provide assistance/on the job training for querying capabilities to EQA Resources as requested and training support teams on various business processes and developing efficient problem management procedures
• Function as Enterprise Quality Assurance Lead on selected projects, operational procedures and release tasks utilizing project management skills
• Lead the team in the approval of the Test Approach, Test Criteria, Tasks, schedule for Strategic Projects based on approved requirements
• Participating in Peer and Solution review of Business and Technical Specifications effecting designated areas of expertise and provide feedback to improve clarity of the specifications and usability of the functionality
• Using SQL, Python or ETL testing frameworks to support regression and data comparison testing

Senior EQA Information Strategy Analyst

System Administrator

• Perform daily monitoring, verifying the integrity and availability of PBD Core systems
• Verify completion of scheduled jobs such as backups, restores, patches, and automating recurring tasks
• Analyze and monitor technology incidents until final resolution
• Develop, modify, and support batch extracts and APIs and write custom programs using various programming languages
• Support IT upgrades, enhancements, new functionality, capacities, performance, cost-effectiveness, and business integrations
• Maintain records on repairs, downtime, and configuration changes
• Administer server operating systems including performance monitoring, troubleshooting, and preventative maintenance
• Assist with disaster recovery and business continuity support
• Maintain service level agreements and measurements

IT Systems Administrator – Associate

Compliance

• Conduct state and federal regulatory research and monitoring to understand PBD’s business registration and license filing obligations
• Receive and review reporting and documentation requests related to PBD’s license submissions
• Evaluate the submission needs and request the necessary data from the applicable PBD business units
• Gather organizational documentation, review responses for accuracy and completeness, and provide the final reporting and documentation for compilation in the required filings
• Assist with the creation and maintenance of tracking and monitoring processes, necessary policies and procedures, performance and reporting requirements, and communicating overall metrics to key stakeholders

PBM Regulatory Compliance Specialist

• Perform monitoring, oversight, and quality assurance reviews/audits of all lines of business as defined by CMS, NYS DOH, NYS DFS and any/all policies and procedures established (as applicable) for assigned operational areas.
• Ensure the quality and accuracy of the systems and processes that support the organization’s operation to meet client government regulatory requirements and compliance plans.
• Track issues identified during the quality assurance process to ensure resolution.
• Analyze, document, and report on results to business stakeholders and company leaders.
• Collaborate with the Quality Assurance team and other cross functional teams to remediate audit findings, to develop and improve testing and audit strategies, techniques, activities, policies and procedures.
• Conduct internal audits to measure and ensure adherence to claims processing standards, technical requirements, supporting processes, systems, and required program documentation.
• Report quality assurance and audit results to management and leadership teams.
• Perform ad hoc queries in audit database in support of decision making.

Quality Assurance Auditor

• analyze utilization, claims, membership, and cost data in support of the Network Contract Management department and corporate strategic initiatives
• design and use analytical tools to draw statistically sound conclusions and present results to management
• interpret, analyze, and recommend courses of action to management as it relates to fair, equitable, and market competitive reimbursement
• support provider contract negotiations, assess the impact of potential alternative reimbursement models
• improve the ability to deliver high quality high value care

Provider Contract & Reimbursement Analyst – Intermediate

Manager

• Apply the six essential activities of case management: assessment, planning, implementation, coordination, monitoring and evaluation
• Develop a plan of care based upon the patient and providers of care clinical assessments
• Continuously evaluate the plan of care within the scope of case management practice
• Act as a patient advocate understanding and identifying potential complications
• Work closely with the payor, providers and all involved team members in evaluating the quality and cost effectiveness of services

Case Manager

Medical Billing and Coding

• Review coding and clinical decisions on cases involving complex clinical presentation
• Aid in training other team members
• Evaluate appeals and share audit trends across the team
• Support the leadership in Hospital Audit in accomplishing all aspects of the audit plan

Senior Clinical & Coding Specialist

• Overseeing the daily operational activities of program strategies to support Pharmacy Benefit Dimension’s accreditations, certifications, licenses, and regulatory requirements
• Oversee reporting requests and the submissions necessary to support them
• Oversee the licensing vendor
• Oversee the policy and procedure process, and activities supporting PBD’s Quality Management Committee and Medicare Part D STAR measures
• Manage the licensing vendor relationship to ensure all reporting, information and supporting documentation is transmitted and necessary applications are filed and tracked ensuring all licenses are acquired and/or maintained
• Oversee the review of standards, regulations and legislation along with the development and implementation of processes and documentation for accreditation, certification, registration and/or licensing
• Oversee project teams and performance of preparation activities for accreditation, certification, registration and/or licensing submissions, mid-cycle audits and renewals
• Manage and lead periodic reviews and mock audits as necessary to ensure PBD is audit ready for accreditation renewals
• Manage the oversight of the Medicare Part D STAR measures dashboard, identify and communicate trends to ensure leadership is able to take appropriate operational action
• Manage the policy and procedure process, policy committee meetings and general daily activities to ensure adherence and provide prompt reporting of instances of actual or potential non-compliance
• Oversee reporting and remediation efforts for instances of non-compliance, including but not limited to corrective action plans and HIPAA privacy and security events.

Manager, Licensing and Regulatory Compliance

Accountant

• responsible for efficient and accurate completion of monthly and annual financial reports
• supporting audit schedules by gathering information needed
• utilizing all resources available to resolve differences
• maintaining the general ledger system
• provide analytical review of the financial statements to management
• prepare and review journal entries
• prepare corporate tax returns as assigned
• produce timely financial information to management to meet monthly deadlines

Intermediate Accountant

Actuary

• Under the supervision of the Manager-Actuarial Services, provide a full scope of actuarial and statistical analyses
• Support both internal and external customers
• Requires working collaboration with other team members and business units throughout the organization
• Support budget development process including forecasting and actual to budget comparison
• Communicate with external departments to support budget preparation
• Support development and forecasting of accruals for Finance and Accounting for various financial statement items
• Provide analysis and reporting for financial and regulatory requirements
• Perform actuarial analysis and modeling including but not limited to reserves, pricing, and forecasting
• Develop ad hoc reports as a supplement to routine management reports through query building and data extraction
• Assist in development of process improvements and automation within the department
• Manage complex projects
• Perform peer review as needed
• Ensure overall data integrity

Actuarial Analyst – Intermediate

• The Manager will be responsible for performing a full scope of actuarial and statistical analyses
• Support both internal and external customers
• Work collaboratively with upper management and other business units
• Assist in the development of process improvements
• Hold meetings with business partners to understand the nature of the business and seek input on specific drivers of the analysis
• Lead results discussions and maintain ongoing communications
• Work with Finance and Accounting to provide financial and actuarial reports on a timely basis
• Oversee preparation of data and analyses for regulatory reporting and for audits
• Provide information to analysts preparing new product development analyses
• Responsible for the analysis of data to support various physician and vendor arrangements
• Support analysis and reporting pertaining to regulatory requirements such as MLR filings
• Lead the development of ad hoc reports as a supplement to routine management reports
• Implement process improvements and automation within the department
• Perform other functions as assigned by management
• Ensure overall data integrity
• Share knowledge with team members

Manager – Actuarial Services

• 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 the guiding principles for case management practice
• adhere to regulatory and compliance requirements
• provide exceptional customer service to all internal and external customers

• Develop, deploy, and maintain role-based logical access processes
• Guide all components of the enterprise approach to critical security functions such as: identity and access management (IAM), privileged identity management, and access controls
• Develop, implement and maintain logical access roles within the SailPoint IdentityNow platform to ensure access is provisioned/deprovisioned at the appropriate times to ensure compliance with corporate policies
• Manage the oversight and maturation of efficiencies in the security functions ensuring adherence to company policy and standards
• Provide governance within the information risk office team and others with regard to the access management and privileged identity management arenas
• Develop, foster, and mature process efficiencies with the goal of reducing time and effort to perform
• Maintain security policies including updates to reflect changing practices and business needs
• Monitor compliance with policies
• Monitor and audit user permissions within applications
• Assist with all user audit activity and fulfillment of internal and external audit requests
• Establish processes to monitor and analyze user and privilege identity access and maintain separation of duties (SoD)
• Develop and maintain process and control documentation supporting IAM services
• Develop training materials related to IAM processes and technologies
• Consult with key business stakeholders to evaluate functional requirements and translate those requirements into information security solutions
• Provide guidance to business partners about applicability of information security to meet business needs
• Support the documentation and accreditation processes necessary to ensure that new IT systems meet the organization's information security requirements
• Respond to crisis or urgent situations to mitigate immediate and potential threats
• Investigate and analyze all relevant response activities
• Represent Information Risk Office in cross-functional meetings and projects
• Develop, foster, and mature process efficiencies with the goal of reducing time and effort to perform
• Participate in the execution of enterprise-wide information security program

Rebates Analyst

IT Business Analyst

Senior EQA Information Strategy Analyst

IT Systems Administrator – Associate

PBM Regulatory Compliance Specialist

Quality Assurance Auditor

Provider Contract & Reimbursement Analyst – Intermediate

Case Manager

Senior Clinical & Coding Specialist

Manager, Licensing and Regulatory Compliance

Intermediate Accountant

Actuarial Analyst – Intermediate

Manager – Actuarial Services

Case Manager

Identity and Access Management Analyst