Experienced Business Analyst - Provider Relations Specialist

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 an Experienced Business Analyst - Provider Relations Specialist 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.

This position works under the general supervision of the Bureau of Children's Services (BCS) Internal Operations and Systems Support Section Manager, within the Division of Medicaid Services.

Here are the details on this position.

Your role in our mission

Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas.

• This position is responsible for establishing protocol and procedures for receiving and reviewing County Waiver Agency (CWA) requests to authorize rates above the Children’s Long-Term Support (CLTS) Waiver Program state service fee schedule, also known as service rate outlier requests, and work with state staff to disseminate information about the process.
• This position will monitor claims compliance in coordination with BCS policy and operation staff, claims processor - Gainwell Technology, and CWA’s.
• This position is responsible for reviewing federal guidance and research other service claims payment systems to implement, review and update the protocol and criteria as required.
• This position is responsible for managing the CLTS service fee schedule. This position is also responsible for researching and resolving discrepancies between written policy and the configuration of claims processing systems.
• This position will be responsible for provider compliance and provider integrity oversight of enrolled service providers in the CLTS program.
• This position will manage provider compliance and provider integrity through established protocol and procedures. Furthermore, the position will develop new processes and criteria, and will be responsible for receiving, analyzing and adjudicating provider integrity concerns and complaints. 
• This position will be responsible for drafting partner and provider communications such as GovD, teleconferences, webinars, bulletins, and newsletter.
• This position is responsible for managing BCS’ provider relations communication inbox and responding to partner and provider questions regarding current coverage, reimbursement, and benefit administration.
• This position is responsible for engaging and resolving concerns and questions from program partners and providers related to claims, provider compliance, and provider enrollment.
• This position will support provider enrollment system and directory projects. This includes serving as a subject matter expert for user acceptance testing in the CLTS provider registry and directory.
• This position will collaborate with policy and operational staff to establish standards for maintaining a directory of compliant providers.

What we're looking for

• Bachelor’s degree in related field or equivalent experience
• Five years of applicable experience, preferably with a human service agency
• Experience developing and implementing policy
• Experience compiling and analyzing financial data, including analysis for impact
• Experience negotiating service rates for health care, community services or non-profit programs
• Ability to interpret regulations and impact of decisions mad