Healthcare Enrollment Validation Specialist - Cognisight
Healthcare Enrollment Validation Specialist Medical Record Department
Full Time (Monday-Friday)
Business Hours with Flexibility
Senior Mgr., Client Operations
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.
- 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%
- New York State Driver’s License
- Independent means of transportation
- Physical ability to travel if necessary
Please forward resumes to Careers@Cognisight.com