Expert Configuration 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 an Expert Configuration 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. In this role you will design, build, and validate the Medicaid Information Technology System (MITS) across functional areas. You will support complex system configuration changes and new configuration requirements, including configuration analysis, design, build and testing. Duties include troubleshooting and fixing system configuration errors, performing investigations and root cause analysis of trouble tickets, and ensuring day to day issues are identified and appropriately addressed.  Here are the details on this position.

Your role in our mission

• Analyze provider contracts / pricing, designs / configures provider agreements, configuration validation, configuration peer review.
• Communicate design to all stakeholders and varying levels of the organization.
• Present and evaluate design solutions objectively and facilitate conflict resolution.
• Define, use, and communicate design patterns and best practices in service-oriented analysis, design, and development.
• Configure new and revised claims adjudication logic within a healthcare claims system.
• Configure products / benefits, providers agreements, fee schedules, and claims payment rules.
• Configure Claim Adjustment Reason Codes and Remittance Advice Code.
• Quality assurance and testing within health plan configuration system (e.g., Facets) to ensure configuration is ready for implementation.
• Collaborate with quality assurance team to ensure testing efforts align with system deliveries and business processes.
• Develop strategies to improve service development life cycle and governance processes.
• Develop and use enterprise service and data models.
• Quality assurance and testing.
• Analyze provider pricing.

What we're looking for

• 9+ years configuration experience working in claims configuration.
• 9+ years of experience identifying patterns within quantitative data, drawing conclusions, and recommending solutions and approaches, skilled with end-to-end issue resolution.
• 9+ years of experience in health care with emphasis in coding, financial rate set up or claims processing in a managed care environment.
• Must be knowledgeable of medical claims data, formats and restrictions including but not limited to Revenue Codes, Place of Service codes, ICD-10 codes, CPT Codes, and Modifiers.
• Experience in Medicaid or Medicare environments.

Preferred Skills / Experience

• Experience in writing requirements for stored procedures
  • SQL
  • PL/SQL
  • Testing stored procedures
• Hands on Configuration experience of Medicaid systems:
  • Provider Contracts
  • Benefits
  • Rates - Provider/Hospital
  • Claims Edits/Audits
• Experience working with data flows and data mapping
• 3M Grouper is a plus
• ClaimsXten is a plus
• Advanced or greater level of proficiency with Microsoft Excel and Word.
• Excellent oral and written communication skills, interpersonal skills and organizational abilities are essential.
• Ability to work effectively without supervision.
• Ability to manage multiple assignments while maintaining quality standards and meeting assigned deadlines.

Additional Required Skills / Experience

• Advanced or greater level of proficiency with Microsoft Excel and Word.
• Excellent oral and written communication skills, interpersonal skills and organizational abilities are essential.
• Ability to work effectively without supervision.
• Ability to manage multiple assignments while maintaining quality standards and meeting assigned deadlines.
• Experience leading teams of 5 or more.

What you should expect in this role

• Fully remote options from most US locations and territories
• Video cameras must be used during all interviews, as well as during the initial week of orientation
• The deadline to submit applications for this posting is May 27, 2024

 

The pay range for