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Healthcare Enrollment Validation Specialist - Cognisight

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Job ID REQ_110884 FACILITY Various Locations LOCATION Rochester, New York

Job Title:Department:

Healthcare Enrollment Validation Specialist                                                    Medical Record Department

Hours:

Full Time (Monday-Friday)

Business Hours with Flexibility

Report To:

Senior Mgr., Client Operations

Job Description:

Provide overall audit support with duties that include, but are not limited to:

  • Proficiency in health plan Demographic and Enrollment and RXC systems and workflows
  • Ability to work in a fast paced, complex organization, with regulated deadlines while providing effective audit support to multiple clients.
  • Develops and maintains excellent relationships; internally within team setting and externally, across large client base.
  • Accountable for performing critical Demographic and Enrollment and RXC audit function with strong attention to detail and 100% accuracy, while navigating multiple client Enrollment and RXC source systems.
  • Creates and maintains documentation in support of CMS mandated audit of health insurance plans’ demographic and claims information.
  • Obtains relevant information towards finalizing deliverables based on client input and requirements from CMS documentation.
  • Own client audit status’ and provide accurate updates, gap discovery and closure planning to Account Management and client
  • Creates, delivers client presentations relative to Demographic and Enrollment and RXC Data Validation Audit regulations, guidelines and client results.
  • Staying apprised of the Department of Health and Human Services (HHS) regulations and guidelines relative to Demographic and Enrollment and RXC Data Validation Audits.

    Requirements:

  • Bachelor’s degree preferred with Healthcare/Health Plan or Medicare/ACA background required
  • Minimum of 3 years’ experience in a healthcare, health insurance, enrollment/claims processing; with proficient knowledge of Risk Adjustment and government audits as demonstrated with health plans
  • High level of professionalism
  • Must be self-directed and escalate concerns with potential solutions
  • Proficiency in Microsoft Office Suite and proprietary software tools
  • Strong written and verbal communication internally and client facing
  • Excellent organizational skills and priority setting for self, team, and client(s)
  • Ability to present to clients
  • Minimal US based travel – not to exceed 10%

Additional Requirements:

  • New York State Driver’s License
  • Independent means of transportation
  • Physical ability to travel if necessary

    Please forward resumes to Careers@Cognisight.com

    Thank you.


Rochester Regional Health is an Equal Opportunity / Affirmative Action Employer. Minority/Female/Disability/Veteran
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