Job Opportunities
Join the Cognisight Team
Job Opportunities
Join the Cognisight Team
If one of the opportunities below piques your interest, please email your cover letter and resume to careers@cognisight.com
If one of the opportunities below piques your interest, please email your cover letter and resume to careers@cognisight.com
CLINICAL REVIEW SPECIALIST
The Clinical Review Specialist will be responsible reviewing medical records to abstract ICD-10 codes that map to HCCs from a variety of different CMS Hierarchy models including Medicare Advantage, PACE, Commercial, and Medicaid CDPS model. In addition to abstracting diagnosis codes, the Clinical Review Specialist also audits medical records and validates entries that have been submitted to CMS.
Responsibilities
- Conducts onsite and remote audits of medical records (paper, EMR, hybrid)
- Adheres to compliance of Medicare, Medicaid, and Commercial risk adjustment guidelines with precision.
- Understands, respects, and applies client specific guidelines
- Adheres to audit and medical record review schedules to meet client expectations and government-regulated deadlines
- Shares trends (positive and constructive) with Coding Manager and Team Leads for client consultation/collaboration
- Regularly participates in peer review; provide and receive feedback
- Ensures accurate documentation to support all audits
- Assures adherence to and currency with internal and external regulatory guidelines:
- CMS/HHS
- DOH
- HIPAA, HITECH, and Fraud Waste & Abuse
- Medical coding protocols
- Provides clinical intellect and expertise to system analytics via project assignments as well as on an ad hoc basis
- Participates on client and prospect conference calls, presentations, and in-person meetings as needed
- Mentors remote contracted staff
- Demonstrates agility to meet client needs
- Maintain coding credentials as required by credentialing agency
- Maintain professional competence as evidenced through attendance in continuing education programs and the like; hours per year dependent on credential(s) held
Requirements
- Coding credential required (RHIT, RHIA, CCS, CPC, optional additional CRC)
- Minimum of one year HCC coding experience required
- Working knowledge of medical necessity
- Knowledge of Medicare Advantage, Commercial, Medicaid, and PACE risk adjustment methodologies preferred but not required
- High level of concentration and precision
- Ability to use a variety of software tools and reporting
- Must be able to work independently
- Preferably located in Rochester, New York
Close
CLINICAL REVIEW SPECIALIST
CLINICAL REVIEW SPECIALIST
The Clinical Review Specialist will be responsible reviewing medical records to abstract ICD-10 codes that map to HCCs from a variety of different CMS Hierarchy models including Medicare Advantage, PACE, Commercial, and Medicaid CDPS model. In addition to abstracting diagnosis codes, the Clinical Review Specialist also audits medical records and validates entries that have been submitted to CMS.
Responsibilities
- Conducts onsite and remote audits of medical records (paper, EMR, hybrid)
- Adheres to compliance of Medicare, Medicaid, and Commercial risk adjustment guidelines with precision.
- Understands, respects, and applies client specific guidelines
- Adheres to audit and medical record review schedules to meet client expectations and government-regulated deadlines
- Shares trends (positive and constructive) with Coding Manager and Team Leads for client consultation/collaboration
- Regularly participates in peer review; provide and receive feedback
- Ensures accurate documentation to support all audits
- Assures adherence to and currency with internal and external regulatory guidelines:
- CMS/HHS
- DOH
- HIPAA, HITECH, and Fraud Waste & Abuse
- Medical coding protocols
- Provides clinical intellect and expertise to system analytics via project assignments as well as on an ad hoc basis
- Participates on client and prospect conference calls, presentations, and in-person meetings as needed
- Mentors remote contracted staff
- Demonstrates agility to meet client needs
- Maintain coding credentials as required by credentialing agency
- Maintain professional competence as evidenced through attendance in continuing education programs and the like; hours per year dependent on credential(s) held
Requirements
- Coding credential required (RHIT, RHIA, CCS, CPC, optional additional CRC)
- Minimum of one year HCC coding experience required
- Working knowledge of medical necessity
- Knowledge of Medicare Advantage, Commercial, Medicaid, and PACE risk adjustment methodologies preferred but not required
- High level of concentration and precision
- Ability to use a variety of software tools and reporting
- Must be able to work independently
- Preferably located in Rochester, NY
Close
CLINICAL REVIEW SPECIALIST
The Clinical Review Specialist will be responsible reviewing medical records to abstract ICD-10 codes that map to HCCs from a variety of different CMS Hierarchy models including Medicare Advantage, PACE, Commercial, and Medicaid CDPS model. In addition to abstracting diagnosis codes, the Clinical Review Specialist also audits medical records and validates entries that have been submitted to CMS.
Responsibilities
- Conducts onsite and remote audits of medical records (paper, EMR, hybrid)
- Adheres to compliance of Medicare, Medicaid, and Commercial risk adjustment guidelines with precision.
- Understands, respects, and applies client specific guidelines
- Adheres to audit and medical record review schedules to meet client expectations and government-regulated deadlines
- Shares trends (positive and constructive) with Coding Manager and Team Leads for client consultation/collaboration
- Regularly participates in peer review; provide and receive feedback
- Ensures accurate documentation to support all audits
- Assures adherence to and currency with internal and external regulatory guidelines:
- CMS/HHS
- DOH
- HIPAA, HITECH, and Fraud Waste & Abuse
- Medical coding protocols
- Provides clinical intellect and expertise to system analytics via project assignments as well as on an ad hoc basis
- Participates on client and prospect conference calls, presentations, and in-person meetings as needed
- Mentors remote contracted staff
- Demonstrates agility to meet client needs
- Maintain coding credentials as required by credentialing agency
- Maintain professional competence as evidenced through attendance in continuing education programs and the like; hours per year dependent on credential(s) held
Requirements
- Coding credential required (RHIT, RHIA, CCS, CPC, optional additional CRC)
- Minimum of one year HCC coding experience required
- Working knowledge of medical necessity
- Knowledge of Medicare Advantage, Commercial, Medicaid, and PACE risk adjustment methodologies preferred but not required
- High level of concentration and precision
- Ability to use a variety of software tools and reporting
- Must be able to work independently
- Preferably located in Rochester, New York
Close
CLINICAL REVIEW SPECIALIST
CLINICAL REVIEW SPECIALIST
The Clinical Review Specialist will be responsible reviewing medical records to abstract ICD-10 codes that map to HCCs from a variety of different CMS Hierarchy models including Medicare Advantage, PACE, Commercial, and Medicaid CDPS model. In addition to abstracting diagnosis codes, the Clinical Review Specialist also audits medical records and validates entries that have been submitted to CMS.
Responsibilities
- Conducts onsite and remote audits of medical records (paper, EMR, hybrid)
- Adheres to compliance of Medicare, Medicaid, and Commercial risk adjustment guidelines with precision.
- Understands, respects, and applies client specific guidelines
- Adheres to audit and medical record review schedules to meet client expectations and government-regulated deadlines
- Shares trends (positive and constructive) with Coding Manager and Team Leads for client consultation/collaboration
- Regularly participates in peer review; provide and receive feedback
- Ensures accurate documentation to support all audits
- Assures adherence to and currency with internal and external regulatory guidelines:
- CMS/HHS
- DOH
- HIPAA, HITECH, and Fraud Waste & Abuse
- Medical coding protocols
- Provides clinical intellect and expertise to system analytics via project assignments as well as on an ad hoc basis
- Participates on client and prospect conference calls, presentations, and in-person meetings as needed
- Mentors remote contracted staff
- Demonstrates agility to meet client needs
- Maintain coding credentials as required by credentialing agency
- Maintain professional competence as evidenced through attendance in continuing education programs and the like; hours per year dependent on credential(s) held
Requirements
- Coding credential required (RHIT, RHIA, CCS, CPC, optional additional CRC)
- Minimum of one year HCC coding experience required
- Working knowledge of medical necessity
- Knowledge of Medicare Advantage, Commercial, Medicaid, and PACE risk adjustment methodologies preferred but not required
- High level of concentration and precision
- Ability to use a variety of software tools and reporting
- Must be able to work independently
- Preferably located in Rochester, NY
Close
ACCOUNT MANAGER
We are seeking a highly organized and detail-oriented individual to join our Account Management team. Managing multiple client accounts, the Account Manager’s responsibilities include maintaining a thorough knowledge of our business and offerings, managing and strengthening client relationships, identifying new business opportunities, and coordinating with internal teams to deliver on internal and external client expectations.
Responsibilities
- Ability to work in a fast paced, complex organization, with regulated deadlines while providing effective account management support to multiple clients
- Managing multiple clients in different time zones while developing strong relationships to ensure customer satisfaction
- Develop client work plans
- Coordinate and manage all client activities aligned to work plans
- Daily monitoring of all aspects of current client activity to meet contracted Statement of Work and Cognisight work flows
- In depth knowledge and ability to articulate all interdependencies associated with client reports
- Strong communication skills to conduct client calls with all levels of leadership
- Develop and deliver client Webinars
- Own all client status’ and provide accurate updates, gaps and gap closing plans regularly to Operation Huddles
- Staying apprised of the Department of Health and Human Services (HHS) regulations, guidelines, and programs and ability to weave into all work flows and articulate with clients
Requirements
- Healthcare/Health Plan or Medicare/ACA background strongly preferred
- Must be self-directed and escalate concerns with potential solutions
- Minimum of 3 years demonstrated experience in Account/Client Management
- High level of professionalism
- Bachelor’s degree required
- Working knowledge of risk adjustment and government audits as demonstrated with health plans
- 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)
- Minimal client travel required
- Must be located in Rochester, NY
Close
ACCOUNT MANAGER
ACCOUNT MANAGER
We are seeking a highly organized and detail-oriented individual to join our Account Management team. Managing multiple client accounts, the Account Manager’s responsibilities include maintaining a thorough knowledge of our business and offerings, managing and strengthening client relationships, identifying new business opportunities, and coordinating with internal teams to deliver on internal and external client expectations.
Responsibilities
- Ability to work in a fast paced, complex organization, with regulated deadlines while providing effective account management support to multiple clients
- Managing multiple clients in different time zones while developing strong relationships to ensure customer satisfaction
- Develop client work plans
- Coordinate and manage all client activities aligned to work plans
- Daily monitoring of all aspects of current client activity to meet contracted Statement of Work and Cognisight work flows
- In depth knowledge and ability to articulate all interdependencies associated with client reports
- Strong communication skills to conduct client calls with all levels of leadership
- Develop and deliver client Webinars
- Own all client status’ and provide accurate updates, gaps and gap closing plans regularly to Operation Huddles
- Staying apprised of the Department of Health and Human Services (HHS) regulations, guidelines, and programs and ability to weave into all work flows and articulate with clients
Requirements
- Healthcare/Health Plan or Medicare/ACA background strongly preferred
- Must be self-directed and escalate concerns with potential solutions
- Minimum of 3 years demonstrated experience in Account/Client Management
- High level of professionalism
- Bachelor’s degree required
- Working knowledge of risk adjustment and government audits as demonstrated with health plans
- 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)
- Minimal client travel required
- Must be located in Rochester, NY
Close
DIRECTOR OF CODING
Provide overall coding department management with duties that include, but are not limited to:
- Ability to work in a fast paced, complex organization, with regulated deadlines while providing consistent high quality results to multiple clients
- Manage coding department leads/managers and coders
- Manage coding recruitment partners
- Fluent and current with risk adjustment coding models and regulations/protocols
- Develop and manage on going coding resource and operational plans to support multiple lines of business while ensuring customer satisfaction, quality and performance metrics
- Daily monitoring of all coding activity to meet contracted Statement of Work and Service Level Agreements
- Strong internal and external communication skills
- Experienced presenter with ability to speak at conferences and with all clients
- Proven experience in working with all levels of leadership internally and externally
- Ownership of ongoing updates from Department of Health and Human Services (HHS/CMS) regulations, guidelines, and programs
- Oversee:
- Team development of internal coding guidelines aligned with CMS and ICD10 coding guidelines
- Coding managers development and delivery of all internal training
- Coding managers development and reporting of all coder performance and quality measurements
- Develop Executive level dashboards to manage daily work and status
- Maintain approximately 2 hours/per week of coding with managers/leads
- Ensure coding staff adheres to all compliance and credential requirements
Requirements
- Health Information Management and or Coding Certification (s) /Certified Professional Coder with 10+ years of a combination of coding and management experience. CPC and/or CRC, RHIT/RHIA required
- HCC and ICD-10 coding experience in Medicare Advantage, Commercial, PACE and Medicaid Managed Care risk adjustment models
- High level of professionalism
- Experienced conference and client presentation skills
- Healthcare/Health Plan or Medicare/ACA background required
- Working knowledge of risk adjustment and government audits as demonstrated with health plans
- Minimum of 5 years demonstrated experience in Coding Leadership Role(s)
- Must be self-directed and strong business acumen
- 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)
- Bachelor’s degree preferred
- Conference and client travel required throughout the United States- approximately 25%
Close
DIRECTOR OF CODING
DIRECTOR OF CODING
Provide overall coding department management with duties that include, but are not limited to:
- Ability to work in a fast paced, complex organization, with regulated deadlines while providing consistent high quality results to multiple clients
- Manage coding department leads/managers and coders
- Manage coding recruitment partners
- Fluent and current with risk adjustment coding models and regulations/protocols
- Develop and manage on going coding resource and operational plans to support multiple lines of business while ensuring customer satisfaction, quality and performance metrics
- Daily monitoring of all coding activity to meet contracted Statement of Work and Service Level Agreements
- Strong internal and external communication skills
- Experienced presenter with ability to speak at conferences and with all clients
- Proven experience in working with all levels of leadership internally and externally
- Ownership of ongoing updates from Department of Health and Human Services (HHS/CMS) regulations, guidelines, and programs
- Oversee:
- Team development of internal coding guidelines aligned with CMS and ICD10 coding guidelines
- Coding managers development and delivery of all internal training
- Coding managers development and reporting of all coder performance and quality measurements
- Develop Executive level dashboards to manage daily work and status
- Maintain approximately 2 hours/per week of coding with managers/leads
- Ensure coding staff adheres to all compliance and credential requirements
Requirements
- Health Information Management and or Coding Certification (s) /Certified Professional Coder with 10+ years of a combination of coding and management experience. CPC and/or CRC, RHIT/RHIA required
- HCC and ICD-10 coding experience in Medicare Advantage, Commercial, PACE and Medicaid Managed Care risk adjustment models
- High level of professionalism
- Experienced conference and client presentation skills
- Healthcare/Health Plan or Medicare/ACA background required
- Working knowledge of risk adjustment and government audits as demonstrated with health plans
- Minimum of 5 years demonstrated experience in Coding Leadership Role(s)
- Must be self-directed and strong business acumen
- 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)
- Bachelor’s degree preferred
- Conference and client travel required throughout the United States- approximately 25%
Close
HEALTHCARE ENROLLMENT VALIDATION SPECIALIST
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
Close
HEALTHCARE ENROLLMENT VALIDATION SPECIALIST
HEALTHCARE ENROLLMENT VALIDATION SPECIALIST
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
Close
ACCOUNTING ASSISTANT
Perform a variety of accounting and data entry duties for the Finance team that include, but are not limited to:
- Ability to work in a fast paced, complex organization, with regulated deadlines
- Collaborate with team members to ensure invoices are received, approved, and paid in a timely manner
- Process the payments of invoices, expense reports, and other payables
- Manage vendor W-9s
- Invoice preparation and accounts receivable
- Other accounting projects as needed
Requirements
- Associates or Bachelors degree required
- Minimum of two years demonstrated experience in Accounting
- Must be self-directed and have a strong business acumen to escalate concerns along with potential solutions
- Proficiency in Microsoft Office Suite
- Strong written and verbal communication skills required
- Excellent organizational skills and priority setting
- Knowledge of QuickBooks
- High level of professionalism
Close
ACCOUNTING ASSISTANT
ACCOUNTING ASSISTANT
Perform a variety of accounting and data entry duties for the Finance team that include, but are not limited to:
- Ability to work in a fast paced, complex organization, with regulated deadlines
- Collaborate with team members to ensure invoices are received, approved, and paid in a timely manner
- Process the payments of invoices, expense reports, and other payables
- Manage vendor W-9s
- Invoice preparation and accounts receivable
- Other accounting projects as needed
Requirements
- Associates or Bachelors degree required
- Minimum of two years demonstrated experience in Accounting
- Must be self-directed and have a strong business acumen to escalate concerns along with potential solutions
- Proficiency in Microsoft Office Suite
- Strong written and verbal communication skills required
- Excellent organizational skills and priority setting
- Knowledge of QuickBooks
- High level of professionalism
Close
FRONT-END WEB APPLICATION DEVELOPER
Front-end web developer is responsible for coding and implementing the visual UI/UX elements that users see and interact with in a web application. The front-end web developer will work with back-end web application developers, who are responsible for the server-side application logic and the integration of the work the front-end developer does. Front-End developers will also have an active role interfacing with UI/UX designs and end-users, as well as participating in uncovering requirements, coding components and elements, document code structure, follow coding standards, and the implementation of application/software solutions for the health system and its affiliates. This includes and may not be limited to logic architecture, technology identification, implementation of third-party applications as it relates to front-end coding tasks, testing and documenting.
Ultimately, the front-end web developer will work with the UI/UX designer and bridge the gap between graphical design and technical implementation, taking an active role on both sides defining how the application looks and functions.
Responsibilities
- Convert UI/UX design wireframes to actual code that will produce the functionality of the visual interface components
- Assist in developing web and mobile applications that modernize healthcare IT
- Actively participate in collaborative design and development sessions
- Code user interfaces to function as intended and that are cross-browser compatible
- Build reusable code and libraries for future use
- Ensure the technical feasibility of UI/UX designs
- Optimize application for maximum speed and scalability
- Assist with maintenance, support, bug fixes, and issue resolution
- Stay current with evaluating new technologies to enhance web product development
- Comment code and assisting with technical documentation
- Assist in the collection and documentation of user’s requirements, development of user stories, and estimates
- Adhere to development principles while delivering solutions on-time and on-budget
- Follow agile SDLC processes, security protocols, and best practices to deliver software solutions
Requirements
- Very proficient in Javascript, HTML, CSS,
- Very Proficient with front end framework such as Reactjs, Redux
- Very Proficient nodejs
- Familiar with non-relational (NoSQL) and relational (SQL) databases
- Familiar with Amazon Webservice
- Ability to adopt to different IDEs
- Proficient in GIT and management of code repositories
- Understanding of object-oriented design, data architecture and development strategies
- Ability to collaborate in a team and highly fast pace agile development environment
- At least 2-3 year experience developing and deploying responsible web sites
- Knowledge of HIPAA, HITECH, HL7 and Healthcare Technology
- Bachelor’s degree in Computer Science, Human Centered Design, Web and Mobile Computing or related technical field, or equivalent combination of education and experience will be considered
- Strong critical thinking/problem-solving skills and capable of solving multiple parts of complex problems independently and with team members
- Robust communication and presentation skills
Close
FRONT-END WEB APPLICATION DEVELOPER
FRONT-END WEB APPLICATION DEVELOPER
Front-end web developer is responsible for coding and implementing the visual UI/UX elements that users see and interact with in a web application. The front-end web developer will work with back-end web application developers, who are responsible for the server-side application logic and the integration of the work the front-end developer does. Front-End developers will also have an active role interfacing with UI/UX designs and end-users, as well as participating in uncovering requirements, coding components and elements, document code structure, follow coding standards, and the implementation of application/software solutions for the health system and its affiliates. This includes and may not be limited to logic architecture, technology identification, implementation of third-party applications as it relates to front-end coding tasks, testing and documenting.
Ultimately, the front-end web developer will work with the UI/UX designer and bridge the gap between graphical design and technical implementation, taking an active role on both sides defining how the application looks and functions.
Responsibilities
- Convert UI/UX design wireframes to actual code that will produce the functionality of the visual interface components
- Assist in developing web and mobile applications that modernize healthcare IT
- Actively participate in collaborative design and development sessions
- Code user interfaces to function as intended and that are cross-browser compatible
- Build reusable code and libraries for future use
- Ensure the technical feasibility of UI/UX designs
- Optimize application for maximum speed and scalability
- Assist with maintenance, support, bug fixes, and issue resolution
- Stay current with evaluating new technologies to enhance web product development
- Comment code and assisting with technical documentation
- Assist in the collection and documentation of user’s requirements, development of user stories, and estimates
- Adhere to development principles while delivering solutions on-time and on-budget
- Follow agile SDLC processes, security protocols, and best practices to deliver software solutions
Requirements
- Very proficient in Javascript, HTML, CSS,
- Very Proficient with front end framework such as Reactjs, Redux
- Very Proficient nodejs
- Familiar with non-relational (NoSQL) and relational (SQL) databases
- Familiar with Amazon Webservice
- Ability to adopt to different IDEs
- Proficient in GIT and management of code repositories
- Understanding of object-oriented design, data architecture and development strategies
- Ability to collaborate in a team and highly fast pace agile development environment
- At least 2-3 year experience developing and deploying responsible web sites
- Knowledge of HIPAA, HITECH, HL7 and Healthcare Technology
- Bachelor’s degree in Computer Science, Human Centered Design, Web and Mobile Computing or related technical field, or equivalent combination of education and experience will be considered
- Strong critical thinking/problem-solving skills and capable of solving multiple parts of complex problems independently and with team members
- Robust communication and presentation skills
Close
CLINICAL REVIEW SPECIALIST
The Clinical Review Specialist will be responsible reviewing medical records to abstract ICD-10 codes that map to HCCs from a variety of different CMS Hierarchy models including Medicare Advantage, PACE, Commercial, and Medicaid CDPS model. In addition to abstracting diagnosis codes, the Clinical Review Specialist also audits medical records and validates entries that have been submitted to CMS.
Responsibilities
- Conducts onsite and remote audits of medical records (paper, EMR, hybrid)
- Adheres to compliance of Medicare, Medicaid, and Commercial risk adjustment guidelines with precision.
- Understands, respects, and applies client specific guidelines
- Adheres to audit and medical record review schedules to meet client expectations and government-regulated deadlines
- Shares trends (positive and constructive) with Coding Manager and Team Leads for client consultation/collaboration
- Regularly participates in peer review; provide and receive feedback
- Ensures accurate documentation to support all audits
- Assures adherence to and currency with internal and external regulatory guidelines:
- CMS/HHS
- DOH
- HIPAA, HITECH, and Fraud Waste & Abuse
- Medical coding protocols
- Provides clinical intellect and expertise to system analytics via project assignments as well as on an ad hoc basis
- Participates on client and prospect conference calls, presentations, and in-person meetings as needed
- Mentors remote contracted staff
- Demonstrates agility to meet client needs
- Maintain coding credentials as required by credentialing agency
- Maintain professional competence as evidenced through attendance in continuing education programs and the like; hours per year dependent on credential(s) held
Requirements
- Coding credential required (RHIT, RHIA, CCS, CPC, optional additional CRC)
- Minimum of one year HCC coding experience required
- Working knowledge of medical necessity
- Knowledge of Medicare Advantage, Commercial, Medicaid, and PACE risk adjustment methodologies preferred but not required
- High level of concentration and precision
- Ability to use a variety of software tools and reporting
- Must be able to work independently
- Preferably located in Rochester, New York
Close
CLINICAL REVIEW SPECIALIST
CLINICAL REVIEW SPECIALIST
The Clinical Review Specialist will be responsible reviewing medical records to abstract ICD-10 codes that map to HCCs from a variety of different CMS Hierarchy models including Medicare Advantage, PACE, Commercial, and Medicaid CDPS model. In addition to abstracting diagnosis codes, the Clinical Review Specialist also audits medical records and validates entries that have been submitted to CMS.
Responsibilities
- Conducts onsite and remote audits of medical records (paper, EMR, hybrid)
- Adheres to compliance of Medicare, Medicaid, and Commercial risk adjustment guidelines with precision.
- Understands, respects, and applies client specific guidelines
- Adheres to audit and medical record review schedules to meet client expectations and government-regulated deadlines
- Shares trends (positive and constructive) with Coding Manager and Team Leads for client consultation/collaboration
- Regularly participates in peer review; provide and receive feedback
- Ensures accurate documentation to support all audits
- Assures adherence to and currency with internal and external regulatory guidelines:
- CMS/HHS
- DOH
- HIPAA, HITECH, and Fraud Waste & Abuse
- Medical coding protocols
- Provides clinical intellect and expertise to system analytics via project assignments as well as on an ad hoc basis
- Participates on client and prospect conference calls, presentations, and in-person meetings as needed
- Mentors remote contracted staff
- Demonstrates agility to meet client needs
- Maintain coding credentials as required by credentialing agency
- Maintain professional competence as evidenced through attendance in continuing education programs and the like; hours per year dependent on credential(s) held
Requirements
- Coding credential required (RHIT, RHIA, CCS, CPC, optional additional CRC)
- Minimum of one year HCC coding experience required
- Working knowledge of medical necessity
- Knowledge of Medicare Advantage, Commercial, Medicaid, and PACE risk adjustment methodologies preferred but not required
- High level of concentration and precision
- Ability to use a variety of software tools and reporting
- Must be able to work independently
- Preferably located in Rochester, NY
Close
ACCOUNT MANAGER
We are seeking a highly organized and detail-oriented individual to join our Account Management team. Managing multiple client accounts, the Account Manager’s responsibilities include maintaining a thorough knowledge of our business and offerings, managing and strengthening client relationships, identifying new business opportunities, and coordinating with internal teams to deliver on internal and external client expectations.
Responsibilities
- Ability to work in a fast paced, complex organization, with regulated deadlines while providing effective account management support to multiple clients
- Managing multiple clients in different time zones while developing strong relationships to ensure customer satisfaction
- Develop client work plans
- Coordinate and manage all client activities aligned to work plans
- Daily monitoring of all aspects of current client activity to meet contracted Statement of Work and Cognisight work flows
- In depth knowledge and ability to articulate all interdependencies associated with client reports
- Strong communication skills to conduct client calls with all levels of leadership
- Develop and deliver client Webinars
- Own all client status’ and provide accurate updates, gaps and gap closing plans regularly to Operation Huddles
- Staying apprised of the Department of Health and Human Services (HHS) regulations, guidelines, and programs and ability to weave into all work flows and articulate with clients
Requirements
- Healthcare/Health Plan or Medicare/ACA background strongly preferred
- Must be self-directed and escalate concerns with potential solutions
- Minimum of 3 years demonstrated experience in Account/Client Management
- High level of professionalism
- Bachelor’s degree required
- Working knowledge of risk adjustment and government audits as demonstrated with health plans
- 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)
- Minimal client travel required
- Must be located in Rochester, NY
Close
ACCOUNT MANAGER
ACCOUNT MANAGER
We are seeking a highly organized and detail-oriented individual to join our Account Management team. Managing multiple client accounts, the Account Manager’s responsibilities include maintaining a thorough knowledge of our business and offerings, managing and strengthening client relationships, identifying new business opportunities, and coordinating with internal teams to deliver on internal and external client expectations.
Responsibilities
- Ability to work in a fast paced, complex organization, with regulated deadlines while providing effective account management support to multiple clients
- Managing multiple clients in different time zones while developing strong relationships to ensure customer satisfaction
- Develop client work plans
- Coordinate and manage all client activities aligned to work plans
- Daily monitoring of all aspects of current client activity to meet contracted Statement of Work and Cognisight work flows
- In depth knowledge and ability to articulate all interdependencies associated with client reports
- Strong communication skills to conduct client calls with all levels of leadership
- Develop and deliver client Webinars
- Own all client status’ and provide accurate updates, gaps and gap closing plans regularly to Operation Huddles
- Staying apprised of the Department of Health and Human Services (HHS) regulations, guidelines, and programs and ability to weave into all work flows and articulate with clients
Requirements
- Healthcare/Health Plan or Medicare/ACA background strongly preferred
- Must be self-directed and escalate concerns with potential solutions
- Minimum of 3 years demonstrated experience in Account/Client Management
- High level of professionalism
- Bachelor’s degree required
- Working knowledge of risk adjustment and government audits as demonstrated with health plans
- 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)
- Minimal client travel required
- Must be located in Rochester, NY
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DIRECTOR OF CODING
Provide overall coding department management with duties that include, but are not limited to:
- Ability to work in a fast paced, complex organization, with regulated deadlines while providing consistent high quality results to multiple clients
- Manage coding department leads/managers and coders
- Manage coding recruitment partners
- Fluent and current with risk adjustment coding models and regulations/protocols
- Develop and manage on going coding resource and operational plans to support multiple lines of business while ensuring customer satisfaction, quality and performance metrics
- Daily monitoring of all coding activity to meet contracted Statement of Work and Service Level Agreements
- Strong internal and external communication skills
- Experienced presenter with ability to speak at conferences and with all clients
- Proven experience in working with all levels of leadership internally and externally
- Ownership of ongoing updates from Department of Health and Human Services (HHS/CMS) regulations, guidelines, and programs
- Oversee:
- Team development of internal coding guidelines aligned with CMS and ICD10 coding guidelines
- Coding managers development and delivery of all internal training
- Coding managers development and reporting of all coder performance and quality measurements
- Develop Executive level dashboards to manage daily work and status
- Maintain approximately 2 hours/per week of coding with managers/leads
- Ensure coding staff adheres to all compliance and credential requirements
Requirements
- Health Information Management and or Coding Certification (s) /Certified Professional Coder with 10+ years of a combination of coding and management experience. CPC and/or CRC, RHIT/RHIA required
- HCC and ICD-10 coding experience in Medicare Advantage, Commercial, PACE and Medicaid Managed Care risk adjustment models
- High level of professionalism
- Experienced conference and client presentation skills
- Healthcare/Health Plan or Medicare/ACA background required
- Working knowledge of risk adjustment and government audits as demonstrated with health plans
- Minimum of 5 years demonstrated experience in Coding Leadership Role(s)
- Must be self-directed and strong business acumen
- 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)
- Bachelor’s degree preferred
- Conference and client travel required throughout the United States- approximately 25%
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DIRECTOR OF CODING
DIRECTOR OF CODING
Provide overall coding department management with duties that include, but are not limited to:
- Ability to work in a fast paced, complex organization, with regulated deadlines while providing consistent high quality results to multiple clients
- Manage coding department leads/managers and coders
- Manage coding recruitment partners
- Fluent and current with risk adjustment coding models and regulations/protocols
- Develop and manage on going coding resource and operational plans to support multiple lines of business while ensuring customer satisfaction, quality and performance metrics
- Daily monitoring of all coding activity to meet contracted Statement of Work and Service Level Agreements
- Strong internal and external communication skills
- Experienced presenter with ability to speak at conferences and with all clients
- Proven experience in working with all levels of leadership internally and externally
- Ownership of ongoing updates from Department of Health and Human Services (HHS/CMS) regulations, guidelines, and programs
- Oversee:
- Team development of internal coding guidelines aligned with CMS and ICD10 coding guidelines
- Coding managers development and delivery of all internal training
- Coding managers development and reporting of all coder performance and quality measurements
- Develop Executive level dashboards to manage daily work and status
- Maintain approximately 2 hours/per week of coding with managers/leads
- Ensure coding staff adheres to all compliance and credential requirements
Requirements
- Health Information Management and or Coding Certification (s) /Certified Professional Coder with 10+ years of a combination of coding and management experience. CPC and/or CRC, RHIT/RHIA required
- HCC and ICD-10 coding experience in Medicare Advantage, Commercial, PACE and Medicaid Managed Care risk adjustment models
- High level of professionalism
- Experienced conference and client presentation skills
- Healthcare/Health Plan or Medicare/ACA background required
- Working knowledge of risk adjustment and government audits as demonstrated with health plans
- Minimum of 5 years demonstrated experience in Coding Leadership Role(s)
- Must be self-directed and strong business acumen
- 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)
- Bachelor’s degree preferred
- Conference and client travel required throughout the United States- approximately 25%
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HEALTHCARE ENROLLMENT VALIDATION SPECIALIST
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
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HEALTHCARE ENROLLMENT VALIDATION SPECIALIST
HEALTHCARE ENROLLMENT VALIDATION SPECIALIST
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
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ACCOUNTING ASSISTANT
Perform a variety of accounting and data entry duties for the Finance team that include, but are not limited to:
- Ability to work in a fast paced, complex organization, with regulated deadlines
- Collaborate with team members to ensure invoices are received, approved, and paid in a timely manner
- Process the payments of invoices, expense reports, and other payables
- Manage vendor W-9s
- Invoice preparation and accounts receivable
- Other accounting projects as needed
Requirements
- Associates or Bachelors degree required
- Minimum of two years demonstrated experience in Accounting
- Must be self-directed and have a strong business acumen to escalate concerns along with potential solutions
- Proficiency in Microsoft Office Suite
- Strong written and verbal communication skills required
- Excellent organizational skills and priority setting
- Knowledge of QuickBooks
- High level of professionalism
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ACCOUNTING ASSISTANT
ACCOUNTING ASSISTANT
Perform a variety of accounting and data entry duties for the Finance team that include, but are not limited to:
- Ability to work in a fast paced, complex organization, with regulated deadlines
- Collaborate with team members to ensure invoices are received, approved, and paid in a timely manner
- Process the payments of invoices, expense reports, and other payables
- Manage vendor W-9s
- Invoice preparation and accounts receivable
- Other accounting projects as needed
Requirements
- Associates or Bachelors degree required
- Minimum of two years demonstrated experience in Accounting
- Must be self-directed and have a strong business acumen to escalate concerns along with potential solutions
- Proficiency in Microsoft Office Suite
- Strong written and verbal communication skills required
- Excellent organizational skills and priority setting
- Knowledge of QuickBooks
- High level of professionalism
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FRONT-END WEB APPLICATION DEVELOPER
Front-end web developer is responsible for coding and implementing the visual UI/UX elements that users see and interact with in a web application. The front-end web developer will work with back-end web application developers, who are responsible for the server-side application logic and the integration of the work the front-end developer does. Front-End developers will also have an active role interfacing with UI/UX designs and end-users, as well as participating in uncovering requirements, coding components and elements, document code structure, follow coding standards, and the implementation of application/software solutions for the health system and its affiliates. This includes and may not be limited to logic architecture, technology identification, implementation of third-party applications as it relates to front-end coding tasks, testing and documenting.
Ultimately, the front-end web developer will work with the UI/UX designer and bridge the gap between graphical design and technical implementation, taking an active role on both sides defining how the application looks and functions.
Responsibilities
- Convert UI/UX design wireframes to actual code that will produce the functionality of the visual interface components
- Assist in developing web and mobile applications that modernize healthcare IT
- Actively participate in collaborative design and development sessions
- Code user interfaces to function as intended and that are cross-browser compatible
- Build reusable code and libraries for future use
- Ensure the technical feasibility of UI/UX designs
- Optimize application for maximum speed and scalability
- Assist with maintenance, support, bug fixes, and issue resolution
- Stay current with evaluating new technologies to enhance web product development
- Comment code and assisting with technical documentation
- Assist in the collection and documentation of user’s requirements, development of user stories, and estimates
- Adhere to development principles while delivering solutions on-time and on-budget
- Follow agile SDLC processes, security protocols, and best practices to deliver software solutions
Requirements
- Very proficient in Javascript, HTML, CSS,
- Very Proficient with front end framework such as Reactjs, Redux
- Very Proficient nodejs
- Familiar with non-relational (NoSQL) and relational (SQL) databases
- Familiar with Amazon Webservice
- Ability to adopt to different IDEs
- Proficient in GIT and management of code repositories
- Understanding of object-oriented design, data architecture and development strategies
- Ability to collaborate in a team and highly fast pace agile development environment
- At least 2-3 year experience developing and deploying responsible web sites
- Knowledge of HIPAA, HITECH, HL7 and Healthcare Technology
- Bachelor’s degree in Computer Science, Human Centered Design, Web and Mobile Computing or related technical field, or equivalent combination of education and experience will be considered
- Strong critical thinking/problem-solving skills and capable of solving multiple parts of complex problems independently and with team members
- Robust communication and presentation skills
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FRONT-END WEB APPLICATION DEVELOPER
FRONT-END WEB APPLICATION DEVELOPER
Front-end web developer is responsible for coding and implementing the visual UI/UX elements that users see and interact with in a web application. The front-end web developer will work with back-end web application developers, who are responsible for the server-side application logic and the integration of the work the front-end developer does. Front-End developers will also have an active role interfacing with UI/UX designs and end-users, as well as participating in uncovering requirements, coding components and elements, document code structure, follow coding standards, and the implementation of application/software solutions for the health system and its affiliates. This includes and may not be limited to logic architecture, technology identification, implementation of third-party applications as it relates to front-end coding tasks, testing and documenting.
Ultimately, the front-end web developer will work with the UI/UX designer and bridge the gap between graphical design and technical implementation, taking an active role on both sides defining how the application looks and functions.
Responsibilities
- Convert UI/UX design wireframes to actual code that will produce the functionality of the visual interface components
- Assist in developing web and mobile applications that modernize healthcare IT
- Actively participate in collaborative design and development sessions
- Code user interfaces to function as intended and that are cross-browser compatible
- Build reusable code and libraries for future use
- Ensure the technical feasibility of UI/UX designs
- Optimize application for maximum speed and scalability
- Assist with maintenance, support, bug fixes, and issue resolution
- Stay current with evaluating new technologies to enhance web product development
- Comment code and assisting with technical documentation
- Assist in the collection and documentation of user’s requirements, development of user stories, and estimates
- Adhere to development principles while delivering solutions on-time and on-budget
- Follow agile SDLC processes, security protocols, and best practices to deliver software solutions
Requirements
- Very proficient in Javascript, HTML, CSS,
- Very Proficient with front end framework such as Reactjs, Redux
- Very Proficient nodejs
- Familiar with non-relational (NoSQL) and relational (SQL) databases
- Familiar with Amazon Webservice
- Ability to adopt to different IDEs
- Proficient in GIT and management of code repositories
- Understanding of object-oriented design, data architecture and development strategies
- Ability to collaborate in a team and highly fast pace agile development environment
- At least 2-3 year experience developing and deploying responsible web sites
- Knowledge of HIPAA, HITECH, HL7 and Healthcare Technology
- Bachelor’s degree in Computer Science, Human Centered Design, Web and Mobile Computing or related technical field, or equivalent combination of education and experience will be considered
- Strong critical thinking/problem-solving skills and capable of solving multiple parts of complex problems independently and with team members
- Robust communication and presentation skills
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