MCT Workstream Analyst (Payment Integrity) - Hybrid (PA/NJ/DE) (Healthcare)

Bring your drive for excellence, team orientation and customer commitment to Independence Blue Cross; help us renew and reimagine our business and shape the future of health care.  Our organization is looking to diversify, grow, innovate and serve, and we are looking for committed, empowered learning-oriented people to join our team.  If this describes you, we want to speak with you.

The Medical Cost Transformation (MCT) Workstream Analysts supports the Workstream Managers in the achievement of medical cost savings targets by assisting with industry and internal research, as well as drawing on robust knowledge of claims processing rules to assist in identifying & quantifying medical cost transformation opportunities as well as internal & external impacts. They also support ideation, investigation, implementation, stabilization and ongoing production work associated with the end-to-end medical cost transformation process within the payment optimization workstream.

 Primary Responsibilities:

• Assist in resolution of internal and external requests related to the payment optimization workstream coming from diverse areas (including but not limited to via Service Now incidents). 
• Assist with monitoring claim editor release notes and updating the Health Rules platform for new or modified edits.
• Provides regular status reports on all outstanding incidents, tickets and tasks.
• Identify, track, and report specific trends and issues related to inquiries and getting claims reprocessed across all platforms.
• Monitor inquiries, tickets and issues, with follow-up regularly with all internal and external partners across multiple related departments.

·       Review and monitor payment optimization vendor reporting, recognizing changes in trends, aged claims with appropriate escalation when needed.

·       Research and root cause internal and external claim questions that may arise from payment optimization workstream vendors and other related MCT initiatives.

·       Maintain vendor task tracker (s) across platforms, ensuring viability for all stakeholders.

·       Other management assigned payment optimization related tasks, as needed. 

 

Qualifications

·       Minimum of 5 years of relevant industry or functional work experience in managed care

·       Advanced EXCEL

·       Advanced claims research and analysis including provider, coding and policy expertise

·       Strong problem-solving skills

·       Skilled in performing research and analysis

·       Self-motivated, ability to succeed in ambiguous environment, and work under tight deadlines with rapidly changing priorities

·       Understands the importance of production inventory management

·       Enthusiasm for analytically intensive work

·       Ability to work collaboratively in a team environment

·       Experience working with claim editors and/or HealthEdge is a plus

Hybrid

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.