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Role Description

As a Carrier Account Manager 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.

• Understand and build relationships with commercial insurance carriers.
• Prepare, monitor, and manage budget and revenue expectations for all assigned carriers.
• Foster collaboration between the Carrier Relations team and all other Gainwell departments.
• Report progress towards strategic carrier growth and identify opportunities to management.
• Coordinate, conduct, and maintain regular communication with multiple health insurance payors and vendors.
• Understand CMS guidelines and State DRA’s, articulating them effectively with carrier and vendor contacts.
• Oversee platform enhancements and manage billing file fixes, 835 remits, checks, and Explanation of Benefits.
• Analyze claims data, procedure codes, bill types, and claim types.
• Identify and continually seek new sources of recoveries, recommending and presenting strategies for increased recoveries or new revenue opportunities.
• Manage the carrier billing process, ensuring cycles are completed and accepted by carriers. Follow claims through the carrier payment processes to receipt of remittances.
• Resolve and rework any denials that can be resubmitted.

Qualifications

• Experience in developing strategic relationships with multiple payors and insurance carriers with excellent negotiation and collaboration skills.
• Knowledge of Medicaid and Medicare and working understanding of HIPAA privacy and security rules.
• Experience working with compliance and legal departments.
• Familiarity with the Health insurance Explanation of Benefits (EOB) generation process.
• Proficiency in data analysis using Microsoft Excel, Word, Access, PowerPoint, SQL, Micro Strategies, and company databases to pose data-related questions and perform root cause analysis.

Requirements

• This is a full-time, permanent salaried (W-2) employee position. This is not a contract or short-term position.
• Health benefits (medical, dental, vision) and paid time off benefits start on day 1 of employment.
• Company match 401K and other benefits available within months of starting.
• New employees are eligible to take advantage of flexible vacation policy after ninety (90) calendar days of employment. Any exception requires manager approval prior to employee's Gainwell start date.
• Company provided computer.
• Monday through Friday work schedule.
• Employees in this role will work from home and must be within the continental US when working.
• Work location must be free of distractions, loud noises, recording devices, and private.
• For remote (work from home) positions employees' Broadband Internet connections should have a minimum speed of 24MBS download and 8 MBS upload.
• Video cameras on phone, tablet, or computer must be used during all interviews. The camera on the company provided laptop must be on during the initial week of orientation, if hired.

Benefits

• The pay range for this position is $55,600.00 - $79,400.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.
• All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance.
• We also have a variety of leadership and technical development academies to help build your skills and capabilities.