ProgenyHealth, LLC

Manager

• The Case Manager will focus on empowering the members’ family to support optimal wellness while advocating for the necessary medical services across the health care continuum.
• Works in a telephonic managed care setting combining strong clinical knowledge and critical thinking to facilitate a plan of care that will ensure quality medical care for the high-risk member population serviced by ProgenyHealth based on the CMSA national standards for case management practice.

Nurse Case Manager – NICU

Director

• Analyze claims and EMR data to quantify the clinical and financial impact of ProgenyHealth programs, including cost, utilization, and outcomes
• Develop and communicate clear, credible ROI narratives for clients and prospective clients
• Partner with clinical, client success, and growth teams to identify where the program is succeeding and where improvement is needed
• Translate ambiguous business questions into structured analyses and actionable insights
• Build and standardize analytical approaches, reporting, and data processes from the ground up
• Serve as a subject matter expert on healthcare cost drivers, reimbursement methodologies, and Medicaid populations
• Present findings to internal leadership and external stakeholders, including clients and prospects

Director of Healthcare Economics

Analyst

• Analyze claims and EMR data to evaluate program performance, including cost, utilization, and clinical outcomes
• Support development of ROI analyses and performance reporting for clients and prospective clients
• Build and maintain recurring and ad hoc analyses, ensuring accuracy and clarity of results
• Translate business questions into structured analyses with guidance from the Director
• Identify trends, outliers, and key drivers within healthcare data and clearly communicate findings
• Partner with clinical, client success, and internal teams to support decision-making and continuous improvement
• Contribute to the development and standardization of reporting, data processes, and analytical approaches
• Prepare clear, concise summaries and presentations for internal and external stakeholders

Senior Healthcare Economics Analyst

Solutions Engineer

• Lead the identification, definition, and documentation of solution architecture, technical design, and interface requirements
• Design end-to-end healthcare interoperability solutions, translating requirements into scalable architecture
• Define architectural patterns, integration approaches, and technical standards
• Create and maintain architecture artifacts including: Solution architecture diagrams, Data flow and system integration diagrams, Interface specifications and technical documentation
• Design and implement integrations using: HL7, FHIR, X12, CCDA, and EDI standards
• Develop and support FHIR APIs and RESTful web services
• Act as a liaison between clients, product teams, engineering, and business stakeholders
• Provide architectural oversight for production interoperability solutions
• Troubleshoot complex interface and data exchange issues
• Monitor integration performance and recommend improvements

Interoperability Solutions Architect

• The Revenue Cycle Analyst supports payment integrity programs for health plan clients
• Managing the downstream financial and operational activities that occur after claim audit or validation
• Tracking audited claims through recovery, adjustment, invoicing, and reporting processes to ensure identified savings are accurately realized, reconciled, and communicated
• Manage post-audit claim inventory across multiple clients, products, and workflows (pre-pay, post-pay, Pre-ProgenyHealth NICU Claims Review)
• Track claims from audit determination through recovery, adjustment, offset, or denial resolution
• Reconcile client-reported recoveries, offsets, and adjustments to auditor findings
• Identify and resolve discrepancies where recoveries do not directly align to original audit findings
• Support recovery calculations when savings are not explicitly reported and must be derived from claims data
• Coordinate the generation and tracking of audit determination letters, overpayment notifications, and related correspondence
• Maintain letter trackers to support timing requirements, regulatory compliance, and client workflows
• Respond to client inquiries related to recovered amounts, claim status, and financial outcomes
• Prepare pre-invoice and invoice support documentation based on recovered or adjusted claim values
• Partner with Finance to validate invoicing accuracy and timing
• Support revenue recognition by ensuring recoveries meet contractual and audit criteria
• Reconcile invoice totals to claim-level recovery detail
• Produce recurring and ad hoc reports on recovery performance, inventory status, and financial outcomes
• Maintain accurate claim-level documentation to support audits, appeals, reconsiderations, and client reporting
• Track claim iterations, adjustments, reversals, and reconsiderations across multiple data feeds
• Identify workflow gaps, data issues, or process inefficiencies impacting recovery realization
• Collaborate with Audit, Coding, Clinical, Client Success, and Product teams to improve revenue cycle workflows
• Participate in quality assurance reviews to ensure consistency, accuracy, and compliance

Nurse Case Manager – NICU

Director of Healthcare Economics

Senior Healthcare Economics Analyst

Interoperability Solutions Architect

Sr. Revenue Cycle Analyst