United States onlyBe part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.
Summary
As an Advisor Business Analyst at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.
Your role in our mission
- Analyze provider contracts / pricing, designs / configures provider agreements, configuration validation, configuration peer review.
- Communicate design to all stakeholders and varying levels of the organization.
- Present and evaluate design solutions objectively and facilitate conflict resolution.
- Define, use, and communicate design patterns and best practices in service-oriented analysis, design, and development.
- Configure new and revised claims adjudication logic within a healthcare claims system.
- Configure products / benefits, providers agreements, fee schedules, and claims payment rules.
- Configure Claim Adjustment Reason Codes and Remittance Advice Code.
- Quality assurance and testing within health plan configuration system (e.g., Facets) to ensure configuration is ready for implementation.
- Collaborate with quality assurance team to ensure testing efforts align with system deliveries and business processes.
- Develop strategies to improve service development life cycle and governance processes.
- Develop and use enterprise service and data models.
- Quality assurance and testing.
- Analyze provider pricing.
What we're looking for
- 9+ years configuration experience working in claims configuration.
- Recent experience with QNXT.
- 9+ years of experience identifying patterns within quantitative data, drawing conclusions, and recommending solutions and approaches, skilled with end-to-end issue resolution.
- 9+ years of experience in health care with emphasis in coding, financial rate set up or claims processing in a managed care environment.
- Must be knowledgeable of medical claims data, formats and restrictions including but not limited to Revenue Codes, Place of Service codes, ICD-10 codes, CPT Codes, and Modifiers.
Additional Skills and Experience
- Experience in writing requirements for stored procedures
- SQL
- PL/SQL
- Testing stored procedures
- Hands on Configuration experience of Medicaid systems:
- Provider Contracts
- Benefits
- Rates - Provider/Hospital
- Claims Edits/Audits
- Experience working with data flows and data mapping
- 3M Grouper is a plus
- ClaimsXten is a plus
- Advanced or greater level of proficiency with Microsoft Excel and Word.
- Excellent oral and written communication skills, interpersonal skills and organizational abilities are essential.
- Ability to work effectively without supervision.
- Ability to manage multiple assignments while maintaining quality standards and meeting assigned deadlines.
- Experience leading teams of 5 or more.
What you should expect in this role
- Fully remote options from most US locations and territories
- Video cameras must be used during all interviews, as well as during the initial week of orientation
The pay range for this position is $86,800.00 - $124,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.
