Provider Reimbursement Analyst - Hybrid (PA/NJ/DE)

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.

Position Summary
The Provider Reimbursement Analyst is responsible for evaluating, developing, and maintaining reimbursement methodologies that ensure fair, accurate, and market‑aligned provider payment. This role conducts complex financial and reimbursement analyses, supports contract development, interprets payment policies, and collaborates cross‑functionally to strengthen network performance.

Key Responsibilities

·Conduct comprehensive reimbursement analyses to assess payment accuracy, financial impacts, and market competitiveness across provider specialties and lines of business.

·Evaluate fee schedule methodologies, CMS updates, contractual payment models, and emerging trends to support the development of strategic reimbursement recommendations.

·Model alternative reimbursement scenarios to forecast financial outcomes and support internal decision‑making.

·Identify cost‑saving opportunities by analyzing trend drivers, aberrant billing patterns, and provider‑level cost variations.

·Convert negotiated contract terms into detailed rate exhibits, payment notes, and reimbursement configuration requirements to ensure accurate system loading.

·Validate contract reimbursement structures for consistency with internal policies, regulatory requirements, and financial assumptions.

·Working independently and/or as part of a team, identify and present cost avoidance and cost recovery opportunities.

·Partner with Contracting to ensure reimbursement language, rate structures, and effective‑date terms are clearly understood and properly documented.

·Collaborate with system configuration teams to ensure timely and accurate implementation of new or updated rate methodologies.

·Investigate reimbursement issues and payment discrepancies by reviewing claims data, contract details, and system logic.

·Provide clear resolutions, payment corrections, and preventive recommendations to avoid recurring issues.

·Support audits, compliance inquiries, and quality reviews by supplying reimbursement analyses, documentation, and clarifications.

·Produce reports, summaries, and presentations that translate technical results into actionable business insights.

·Perform additional responsibilities as required to support departmental goals, operational needs, and strategic initiatives.

Qualifications

·Bachelor’s degree in Business, Finance, Healthcare Management, Information Science, or a related field; Master’s degree preferred.

·Strong analytical and problem-solving skills.

·Advanced proficiency in Excel, Access, Word and SQL.

·Strong organizational skills and ability to manage multiple projects simultaneously

·Excellent verbal and written communication skills required.

·Experience analyzing claims data, fee schedules, and reimbursement methodologies is required.

·Aptitude for detail-oriented work.

·Ability to work independently and as part of cross functional teams.

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.