Gainwell Technologies
Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.
Business Analyst - Provider Relations Specialist
March 13
Gainwell Technologies
Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.
📋 Description
• Be part of a team that unleashes the power of leading-edge technologies to help improve health and well-being. • 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 contribute your skills to improve the health and well-being of vulnerable members. • Connect your passion with purpose, teaming with people who thrive on finding innovative solutions. • Play a critical role in ensuring clients’ objectives are met in important areas. • Responsible for establishing protocols and procedures for County Waiver Agency requests. • Monitor claims compliance in coordination with policy and operation staff. • Review federal guidance and research service claims payment systems. • Manage the CLTS service fee schedule and provider compliance oversight. • Develop new processes and criteria to address provider integrity concerns. • Draft communications with partners and providers regarding reimbursement and benefit administration. • Support provider enrollment system and directory projects as a subject matter expert.
🎯 Requirements
• 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 made • Ability to facilitate effective training and related resources • Knowledge of community-based waiver programs and services • Knowledge of the federal Centers for Medicare & Medicaid Services (CMS) Home and Community-Based Services (HCBS) waiver program requirements • Knowledge of Medicaid programs and cost allocation methodologies • Skills and experience in providing training, technical assistance and monitoring • Experience developing standard protocols for ongoing operations to multi-task with logical business priorities
🏖️ Benefits
• Generous, flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies
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