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Cognosante is on a mission to transform our countrys healthcare system. We are a health IT Company who helps public sector organizations do everything from strategic consulting and acquisition support to application development, data integration, data standards, and business process operations. Learn how we are making a difference in peoples lives today!
The Case Management Analyst - IV will be a part of a team supporting development and implementation of case analysis work for reconciliation of data from the health insurance exchanges. The Analyst is responsible for efficient and timely hands-on troubleshooting, remediation, coordination, escalation, tracking and management. Responsible for conducting research, workflow investigations, business procedures and making recommendations.
The Case Management Analyst - IV will also be responsible for continuous process improvement of the reconciliation process. He/she will provide content to and for collaboration with training staff on training stakeholders on triaging transactions and the reconciliation process.
Employee is expected to undertake any additional duties as assigned by Manager.
Gather information from consumers and apply triage, research, collaboration, and policy knowledge to resolve the consumers Marketplace enrollment and processing issues
Inform consumers of the results of their 1095-A Correction Request
Understand and properly use and interpret various federal policies, regulations, and systems in response to consumer inquiries about Marketplace enrollment issues
Follow all call scripts, Standard Operating Procedures, and knowledge articles when responding to caller inquiries about enrollment or 1095A issues
Have knowledge of all major Cognosante HDC operating systems
Identify processing deficiencies and initiate corrective actions to improve work processes
Manage daily personal voicemail and consumer callbacks
Explore answers and alternative solutions to consumer issues; implements solutions, escalates unresolved problems
Answer consumer inquiries by researching, locating, providing desired information
Inform clients of enrollment issue resolution by explaining procedures; answering questions; providing information
Maintain and improve quality results by adhering to standards and guidelines; recommending improved procedures
Update job knowledge by studying new scripts; participating in educational opportunities
Effectively communicate with both internal and external clients
Provide exceptional customer service
Consistently provide accurate and timely documentation of daily activities and results
Maintain accountability, reliability and dependability when performing all assigned job duties
Participate in training sessions required by the Federal Government and Cognosante
Analyze and respond to complex questions relating to program eligibility, plan enrollment, and other policy-related issues for multiple stakeholders
Review Marketplace cases escalated due to complex and multiple policies or issues
Provide peer review
Respond to complex questions relating to program eligibility, plan enrollment, and other policy-related issues
Review regulations and other policy documents from Centers for Medicare & Medicaid Services (CMS) to assess impact to business operations, including processes and communications
Review and create all application modifications (834s) required for case resolution
Work with Casework Supervisor to conduct trainings as needed
Serve as subset of Policy SMEs in addition to the Team Lead and Manager
Provide updates and oversight on ISO certified project policy and work instruction
Work with Team Lead and Manager to coordinate all special projects/tasks
Work with Team Lead and Manager to summarize and present extremely complex and unique cases to internal stakeholders and/or CMS representatives for clarification and guidance during Case Review Sessions
Support Direct Referral cases from CMS that require advanced resolution
Education: Bachelors degree or 2 years of college and 2 years of relevant experience or 4 years of relevant experience
Experience or education with project management tools and methodologies
Excellent communication skills
Excellent problem-solving skills
Excellent customer service skills
Additional Required Minimum Qualifications
Expert case analysis skills
Resolves customer dispute discrepancies
Candidates that do not meet the required qualifications will not be considered.
Experience in enrollment transactions
Experience with Affordable Care Act
Strong written and oral communication skills
Advanced customer service telephone skills and the willingness to make outbound and receive inbound telephone calls
Proficiency in Microsoft Word, Excel, Power Point, SharePoint
Experience with Federal contracts desired
Experience with 834 enrollment transaction process desired
Were on a mission to transform our countrys healthcare system.
Each of our 1,700+ colleagues across the United States plays a role in transforming the lives of millions of Americans. This mission drives us - and it adds meaning to what we do, each and every day. Our passion for serving public health programs, and for engaging consumers more directly with the healthcare system, runs deep.
Passion for what we do. Pride in how we do it. At Cognosante we are all VIPS.
We create value be being enterprising. We develop innovative ideas and solutions. We perform at our best and deliver results. We share achieved results and recognitions.
Cognosante was founded to address a critical gap in the health IT market the need for a smart, nimble company, unencumbered by legacy systems and unafraid to challenge accepted wisdom. Experience grounds us; innovation drives us. For almost 30 years, weve worked to find progressive solutions to complex problems.
We help state Medicaid agencies navigate healthcare reform. We provide community-based assistance to Americans as they enroll in healthcare coverage. And we dream of, design, and develop IT solutions meant to disrupt the status quo and connect the dots between patients, plans, providers, and payers. We are the best minds on health - and were looking to grow our team.
Are you ready to make a difference in the lives of millions? Join us.
Highlighted Benefits for Full-time Employees
Medical Dental Vision 401k Flexible Spending Accounts Paid Time Off Work/Life Solutions Pet Insurance
Cognosante is an equal opportunity employer at https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm . We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics. If youd like to view a copy of the companys affirmative action plan or policy statement, please email email@example.com . Cognosante is committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation because of a disability for any part of the employment process, please send an e-mail to firstname.lastname@example.org and let us know the nature of your request and your contact information.
T o all recruitment agencies: Cognosante does not accept unsolicited agency resumes. Please do not forward unsolicited resumes to our requisitions, any Cognosante email address, any Cognosante employee, or to any company location. Cognosante is not responsible for any fees related to unsolicited resumes.
Company - Private
$100M to $500M