ProgenyHealth, LLC

Customer Success Manager

• Lead all aspects of client operations and engagement
• Act as the primary advocate for health plan clients
• Coordinate and drive meetings connecting us to clients’ needs and goals
• Facilitate discussions ensuring every voice is heard
• Document actionable steps and share insights
• Analyze and organize client change requests for seamless execution
• Build strong relationships with client leaders and teams
• Handle contracts, systems, and performance guarantees confidently
• Champion our services and value proposition
• Develop and present client-facing materials
• Ensure high-quality client-specific reporting
• Take decisive action and escalate issues as needed to protect clients’ interests.

Client Success Manager

• Independently develop and execute strategic plans, including comprehensive relationship management strategies.
• Lead Maternal and Infant Health business consultations, conduct operational reviews, and present annual ROI in business reviews.
• Drive retention and cross-sell expansion for your assigned portfolio of clients (5-7 accounts).
• Take ownership of processes to ensure exceptional service delivery and compliance with all contract requirements.
• Build and maintain close relationships with clients and clinicians (MDs, RNs, CMs, etc.), independently understanding their environments, missions, and initiatives within health plans and across states.
• Analyze and present clinical Key Performance Indicators to clients with confidence and clarity.
• Demonstrate a deep understanding of all ProgenyHealth services and our value proposition, and communicate this effectively to clients.
• Plan, organize, and lead strategic client events such as quarterly and annual meetings as a true individual contributor.
• Utilize your expert problem-solving skills to work both independently and collaboratively within teams when needed.

Client Success Executive

Manager

• The Social Worker will work in conjunction with the Nurse Case Managers, coordinating care of the high-risk newborn population served by ProgenyHealth based on the CMSA national standards for case management practice.
• The Social Worker will demonstrate strengths in working independently as well as collaboratively within a team environment.
• An understanding of ProgenyHealth goals and outcome measures is important to the accountability of the Social Worker and the success of the member-focused Specialty Care Management Programs.
• Focus on empowering the caregiver and family to support optimal wellness while advocating for the necessary services and community resources across the health care continuum.
• Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care.
• Build and maintain relationships with caregivers and healthcare providers to develop an individualized plan of care that is member focused and addresses physical and psycho-social barriers to optimal outcomes.
• Identify any impediments to member progress and advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the healthcare team.

Bi-lingual Maternity Case Manager, LCSW, NE License

Auditor

• The Clinical RN Chart Reviewer will perform clinical reviews of medical records and other documentation to validate issues of claims coding accuracy, medical necessity, and the appropriateness of treatment settings and services delivered.
• The Clinical RN Chart Reviewer will report to the Payment Assurance Manager and support a culture and work environment that promotes and inspires an active, continuous improvement philosophy regarding products and services in line with our company mission.
• Responsibilities will include:
• Audits and analyzes neonatal intensive care unit (NICU) claims according to ICD-10 coding principles and clinical guidelines.
• Analysis of claims data to optimize reimbursement by ensuring that the diagnosis codes, procedure codes, and supporting documentation accurately support the service rendered.
• Ensures claims analysis complies with ethical coding standards, guidelines, and regulatory requirements.
• Responsible for performing clinical reviews of medical records and other documentation to validate issues of claims coding accuracy, medical necessity, and the appropriateness of treatment settings and services delivered.
• Utilize Clinical Review Tools and EMR Systems.
• Research reimbursement regulations for claim payment compliance to support and validate audit findings.
• Assist with the development of claims audit process documentation, including workflow diagrams, policies and procedures, and standard operating procedures.
• Detect discrepancies in provider billing and recommend adjustments to ensure proper reimbursement.

Nurse Inpatient Coding Auditor, CIC or CCS Certified

Bilingual

• Assist the Case Management department in the administration of CM functions
• Conduct telephonic outreach to members and monitor their eligibility
• Update database information and research support services for families
• Support Case Managers by developing communication with members
• Document member and provider information in medical management database
• Complete scripted introduction calls to Provider offices
• Transfer questions of a clinical nature to Nurse Case Manager
• Attend and participate in Quality Improvement meetings and training sessions

Bilingual Case Management Associate – Maternity

Data Analyst

• Schedule design sessions and meet with internal Stakeholders to develop reporting/dashboard requirements and UAT plans
• Provide ongoing reporting support for dashboards, reports, master data management and metadata management layers
• Investigate performance issues with dashboards, reports, and ad-hoc query environments and mitigate those issues
• Deploy work through our continuous integration/continuous deployment (CI/CD) model
• Track and update work within Azure DevOps using best practices
• Use technical documents such as data dictionaries to develop analytics
• Participate in Release Management meetings
• Provide support to Data Analyst Intern and Junior Data Analysts as requested by leadership

Solutions Engineer

• Leads the identification, definition, and documentation of solution architecture, technical design, and interface requirements through thorough analysis of technical and business processes
• Serves as a liaison between clients, health services, technology, and training teams to determine appropriate EDI and interoperability solutions, and to review, identify, clarify, and resolve solution requirements
• Identifies inconsistencies, risks, and gaps within complex business, data, and integration workflows
• Provides architectural guidance and oversight to business analysts and engineers in planning, analysis, and execution of requirements and solution documentation