Be 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 a Carrier Analyst at Gainwell, you will be a part of an innovative healthcare technology company with a mission to serve the healthcare needs of our communities. You will use your network testing and network management skills to drive the development of healthcare administration products used, and relied upon, by millions of patients. Most importantly, you’ll have the chance to grow and develop as a professional through our exceptional developmental opportunities. 

​

Your role in our mission 

​
Develop your career as you support Gainwell’s focus on creating innovative, purpose-built technologies and solutions to deliver better health and human services outcomes.

 

• Work with carriers legal or compliance teams to submit, review and obtain signed agreements.
• Work with HMS legal and compliance departments to review DUA’s and/or TPA’s.
• Understand CMS guidelines and State DRA’s with the ability to articulate with C-level carrier contacts.
• Develop strong working relationships with the carrier contacts.
• Assist with recruiting 50% of the market share reporting lives.
• Research, identify and pursue new opportunities to obtain additional carrier eligibility/membership data.   
• Work with carriers to identify data needs by leveraging required vs desired documentation for implementation.   
• Assist and educate the carriers in defining the approach for data acquisition. 
• Research and resolve UFI (unable to identify files) with EDM.
• Perform outreach and resolve missing eligibility file tickets.
• Assist with Tier 4/5 carrier recruitment.
• Respond to data request in support of the RFP process.   
• Prepare market share reporting for our Medicaid and Medicaid Managed Care Clients   
• Assist with administrative tasks for the DUA tables, GUI and MUP files. 
• Identify and track protocols that need to be automated by leveraging Destination and Carrier Business Rules
• Respond to ConnectUs tickets in a timely fashion.
• Assist with maintaining the carrier recruitment tracker.
• Update TPLCARR1 tables with new recruitments
• Create and update carrier recruitment hand-off documentation. 
• Work with AV Team to advise them of new recruitments for portal set-up.
• Support results and/or sustaining accelerator initiatives.
• Work closely with other carrier recruiter and management team
• Develop strong working relationships with EDM, Operations and Account Management
• Reviewing data and driving process improvements
• Analyzing data to seek out additional recoveries.

 

 

What we're looking for 

• 2+ years related work experience; healthcare/insurance industry preferred.
• Knowledge of Medicaid and Medicare
• Working knowledge of HIPAA privacy and Security rules
• Ability to analyze data, ask data related questions and perform root cause analysis.
• Experience working with compliance and legal departments.
• Experience with SQL and ability to do Analysis of claims data.

 

 

What you should expect in this role

 

• Opportunities to travel through your work (0-10%)
• Fully remote opportunity with the option to work anywhere within the United States

 

 

#LI-REMOTE

#LI-AI1

#LI-GR1
 

 

The pay range for this position is $55,600.00 - $79,400.00 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 wh