MCT Workstream Manager (Payment Integrity) - Hybrid (PA, NJ, DE)

Medical Cost Transformation Workstream Manager

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.

The Medical Cost Transformation Workstream Manager supports the achievement of medical cost savings targets by conducting extensive industry and internal research as well as drawing on robust knowledge of claims coding and claims processing rules to identify and quantify medical cost transformation opportunities, as well as internal and external impacts. They are the relationship manager for assigned payment optimization vendor(s) and also manage the MCT payment optimization ideation, investigation, business case development, implementation, stabilization, and on-going production phases of the end-to-end process.

Primary Responsibilities :

• Conducts competitor analysis of medical cost transformation opportunities through extensive industry research of medical societies, national carriers, and blue plans which may be initiated via the assigned vendor(s) or internal.
• Facilitates workstream meetings and related ad-hoc forums designed to facilitate the investigation of identified opportunities; ensures action steps are clearly defined, accountable individuals are identified, timelines are established, and follows up to ensure closure.
• Helps compile / develop the business intelligence necessary to fully define and articulate identified opportunities :
• Ensures necessary data is produced, analyzed and accurately interpreted
• Investigate IBX status quo, market precedent, degree of disruption (provider, member, other stakeholder)
• Supports assessment of alternative approaches to value capture and recommends approach
• Manages issue resolution for initiatives in implementation and production; completes research and follow-ups to ensure closure.
• Day to day contact for assigned payment optimization vendor(s), overseeing vendor billing, invoicing, and reporting.
• Supports internal and external communications related to payment optimization initiatives and on-going education.

Qualifications

Independence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania.

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.