Carrier Account Manager (Remote in US)

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 Carrier Account Manager, you will play a key role in managing relationships with commercial insurance carriers and vendors. Your contributions will directly support strategic initiatives and revenue recovery efforts while ensuring a seamless billing and claims process. This is an opportunity to connect your skills with purpose and make a tangible impact in the healthcare space.

 

 

Your Role in Our Mission

• Build and maintain strong working relationships with commercial insurance carriers.
• Prepare, track, and manage budgets and revenue expectations for assigned carriers.
• Foster collaboration across departments, especially between the Carrier Relations team and internal stakeholders.
• Provide reporting on strategic carrier growth and identify new business opportunities.
• Maintain consistent communication with multiple payors and vendors.
• Understand and communicate CMS guidelines and State DRA requirements to external partners.
• Oversee platform enhancements, manage billing file updates, and troubleshoot issues related to 835 remits, checks, and EOBs.
• Analyze claims data including procedure codes, bill types, and claim types.
• Identify new recovery opportunities and recommend strategies for increasing revenue.
• Ensure billing cycles are executed, and claims are followed through to remittance.
• Resolve and resubmit denials where appropriate.

 

 

What We’re Looking For

• Education: Bachelor’s degree is required.
  • Any additional certifications in coding, billing, or practice management (PM) will be a strong plus.
• Should have 1–2 years of work experience in the healthcare industry, Medicaid/Medicare. Experience developing strategic relationships with multiple insurance payors and carriers.
• Strong attention to detail with excellent negotiation and collaboration abilities.
• Knowledge of Medicaid, Medicare, and CMS regulations. Familiarity with HIPAA privacy and security requirements. Experience working with compliance and legal teams.
• Understanding of the EOB generation process and insurance claim workflows.
• Strong data analysis skills using tools such as Microsoft Excel, Access, SQL, PowerPoint, and company databases. Ability to analyze data sets, identify trends, and perform root cause analysis – Expert Analytical Skills. Exceptional reporting and presentation skills for both internal and external audiences.
• Experience with Anthem Payor and/or Availity Vendor is a significant plus.

 

 

What You Should Expect in This Role

• Permanent full-time role (W-2) – not a contract or temporary position.
• Comprehensive benefits including medical, dental, vision, and paid time off – starting on Day 1. Paid time off available after 90-days.
• Company-provided laptop and tools.
• Monday through Friday schedule 8am to 6pm with flexibility to support partners in different time zones.