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Role Description

As a Senior Business Analyst - Managed Care Entity 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.

• Work collaboratively with the client and team members - both external and internal to the company - to research, validate and document business needs.
• Ensure that those needs are clearly reflected and completed.
• Assist with translating client requests and changes into the MMIS.
• Effectively manage client’s expectations.
• Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas.
• Ensure that items are prepared for client/MCE meetings.
• Ensure Operating Procedure Manuals are updated as required.
• Work with the client on claims research, change requests, and suspended claims.
• Research, identify, and specify solutions to problems.
• Create and update documentation for projects.
• Assist with Managed Care Entity encounter meetings, questions, and research.

Qualifications

• 5+ years of Healthcare Claims experience.
• Certified coder is a plus.
• Good understanding of CPT, HCPCS, and ICD-10 coding.
• Hands-on experience with Encounter Claims (shadow billing), required to track and follow EC mailbox.
• Must be proficient in Excel.

Requirements

• Must work collaboratively in a team environment.
• Build relationships and work collaboratively internally and externally.
• Effective verbal/written communication.
• Ability to assist/create manual documentation as well as provider notifications.

Benefits

• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Variety of leadership and technical development academies to help build your skills and capabilities.

Company Description

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.