Managed Care Business Analyst

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. 

 

Summary

As a Managed Care 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

Gainwell empowers you to show you’re a pro and help clients deliver better health and human services outcomes using innovative technology and solutions.

• Analyze, plan, design, document and make recommendations to improve business processes to support client’s technological aspirations 
• Create, execute or analyze basic test scenarios to verify that client requirements are built into system design
• Ensure that “intent of change” is carried out through every project phase by participating in technical reviews and inspections
• Strong oral/written communication skills
• Ability to read, understand, and interpret complex regulatory and procedural documents
• Time management and organizational skills
• Ability to work independently without frequent supervision
• Strong analytical skills
• Ability to successfully interact with other departments
• Working knowledge of Medicaid, Member, Premium Billing and Managed Care processes, policies and system logic
• Flexibility with the ability to multi-task
• Ability to work more than a 40 hours work week when required

 

Under minimal direction, provide analyst expertise to staff, management and customers within a health care environment. Provide support to providers, members and enrollment specialists on a daily basis.

Additional Responsibilities

• Coordinate managed care contract activities, participate in policy design, testing and program implementation functions related to the Member, Premium Billing and Managed Care subsystems. Work daily member and managed care related tasks from KMMS. Coordinate QA activities for Managed Care unit. Assist Managed Care Unit and other units with tasks as assigned by Supervisor.
• This Analyst will be part of the Managed Care and Premium Billing Team. The team is responsible for the promotion, enrollment, maintenance and education of the Managed Care program and Premium Billing functions.  The analyst is to take an active lead role in the support of Managed Care Unit and Premium Billing activities and responsibilities, including but not limited to those listed above. The Analyst must coordinate with other KMMS functional areas, such as Customer Service, Claims Processing, TPL, Prior Authorization, Policy and SURS. This position is a salaried position and is open to current employees.

What we're looking for

• Three or more years of experience Business Analyst experienced, translating technical goals and requirements into real action for clients
• Bachelor's degree or equivalent combination of education and experience
• Experience with Kansas Modular Medicaid System and Kansas Medicaid
• Strong analytical and problem solving skills
• Strong written and oral communication and presentation skills to deliver messages to business leaders, clients and technical personnel
• Ability to work in a team environment with multiple team members

What you should expect in this role

• Fully remote options from most US locations and territories