Payment Analytics Ideation, Senior Professional

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.

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 Ideation Analyst - Healthcare Reimbursement 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

• Develop and implement new data mining opportunities for identifying healthcare overpayments made to providers by insurance companies through data review and analytics.
• Act as a senior member of the team and help to assist lower-level analysts.
• Research industry standard guidelines, State/Federal regulations, and client billing and reimbursement policies, to develop and configure improper payment algorithms.
• Review provider contracts to identify algorithms for the identification of contractual based overpayments.
• Implement current Payment Analytics concepts for new and existing clients by ensuring client policy is supportive and properly applied.
• Support the appeals, validation, and client services team in resolving outstanding issues regarding production queries.
• Ensures individual and departmental goals are consistently met or exceeded, in collaboration with other team members and management.
• Reviews IT programming results for quality assurance and proof of concept validation.
• Documents query results and prepare internal and external documentation and presentations related to new overpayment issues.
• Works with internal operations and clinical teams to develop, implement, review and audit protocols and internal review guidelines.
• Works with engineers to develop and implement technological improvements that will support the audit process.
• Contributes new ideas for improving existing audit processes and audit queries.  

 

What we’re looking for

• 5+ years Healthcare Reimbursement experience such as Provider Contract Development, Healthcare Claims Analysis, Medical Billing/Coding, Patient Accounting, Claims Auditing, and/or Revenue Cycle Improvement required.
• Experience in Healthcare Auditing, reviewing and validating the accuracy of claims data and accuracy of claims payment preferred.
• Experience applying published Healthcare Guidelines such as CMS Regulations and Coding Guidelines to Healthcare Claims Data, Recovery Audit experience preferred.

 

What you should expect in this role

• Fully remote opportunity with the option to work anywhere within the United States
• Opportunities to travel through your work (0-10%)
• Video cameras must be used during all interviews, as well as during the initial week of orientation

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The deadline to submit applications for this posting is June 21, 2025 

The pay range for this position is $69,400.00 - $99,200.00 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