Client Services Analyst I

November 14

🤠 Texas – Remote

Although this job is listed in Texas, this company may be open to hiring remote in other states.

💵 $35.9k - $51.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📁 Client Services

🦅 H1B Visa Sponsor

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Gainwell Technologies

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Healthcare Insurance • Human Services • Healthcare

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.

10,000+ employees

⚕️ Healthcare Insurance

💰 Grant on 2023-06

📋 Description

• Ensures correct prior authorization/referral form is completed for patient’s plan • Reviews medical necessity documents for accurate information to include patient provider identification information, clinic or procedure requested, and appropriate CPT/Diagnosis codes to verify the accuracy and completeness of information submitted by healthcare providers • Ensures diagnoses, procedures, and services are correctly documented, in accordance with industry standards and regulatory requirements • Validates the appropriateness of prior authorization requests and referrals based on established policies, contracts, and medical guidelines • Identifies discrepancies or inconsistencies and appropriately communicate them for further investigation • Monitors prior authorization requests and referrals processing activities to ensure adherence to legal and regulatory requirements, such as HIPAA, CMS guidelines, and contractual obligations • Updates systems with patient information and actions to ensure timely claims payment • Achieves daily, monthly, and quarterly quality and productivity KPIs • Secures patient demographics and medical information, ensuring HIPPA compliance

🎯 Requirements

• Experience in processing prior authorization and referral requests, handling medical claims, and verifying member eligibility in a healthcare setting • Proficient in interpreting Explanation of Benefits (EOB) and UB-04 claim forms, with working knowledge of CPT, HCPCS, DRx codes, and service types • Familiarity with insurance payers, medical benefits, and pre-authorization procedures; understanding of Medicaid policies and medical coding (ICD-10, CPT, HCPCS) is a plus • Strong analytical and critical thinking skills to identify delays, resolve issues, and ensure data accuracy and reconciliation across systems • Excellent communication skills with a professional, customer-focused approach; ability to work effectively within a team and independently • Proficient in Microsoft Excel, Visio, and PowerPoint; must be available to work during prior authorization hours (7:00 AM – 6:00 PM Eastern Time)

🏖️ Benefits

• Most benefits start on first day of employment • Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies