
10,000+ employees
đŒ Consulting
đŠ Logistics
âïž Healthcare Insurance
đ° Grant on 2023-06
Consulting âą Logistics âą Healthcare Insurance
Gainwell Technologies is the nationâs 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.
đ„ 5 minutes ago
đșđž United States â Remote
đ” $84.8k - $121.1k / year
â° Full Time
đ Senior
đŽ Lead
đ Compliance
đŠ H1B Visa Sponsor
đ» Ghost score 0%
Where this job comes from
Posted on Gainwell Technologies's careers page, not through a job board
First seen by Remote Rocketship 5 minutes ago

10,000+ employees
đŒ Consulting
đŠ Logistics
âïž Healthcare Insurance
đ° Grant on 2023-06
Consulting âą Logistics âą Healthcare Insurance
Gainwell Technologies is the nationâs 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.
âą Support the Director of CX Business Compliance in translating approved requirements into consistent, evidence-based practices across Customer Experience accounts âą Provide day-to-day compliance oversight, consultative guidance, escalation coordination, reporting, and implementation support for member and provider account access, provider EFT, and portal administrator changes âą Provide functional oversight of verification-review activities performed by Verification Specialists and Senior Verification Specialists âą Monitor adherence to approved requirements, identify control gaps and recurring issues, provide compliance guidance, and escalate findings âą Coordinate reviews of account work and independent quality reassessments âą Support audit-the-auditor reviews, sampling, calibration, root-cause analysis, and corrective-action validation âą Monitor authentication, identity and representative authority validation, trusted contact sources, outbound verification, approved scripts, and recording requirements âą Serve as an escalation contact for complex, disputed, incomplete, or high-risk matters, including potential fraud, privacy, or security concerns âą Partner with Privacy, Security, Legal, Risk and Compliance, Operations, Quality, Technology, Training, implementation teams, and account leadership âą Support quality monitoring and secret shopper programs, communicate findings, coordinate corrective actions, and track recurring issues through resolution âą Draft and maintain policies, SOPs, scripts, checklists, and work aids âą Coordinate role-based training, knowledge checks, access requirements, refresher training, and production-readiness activities âą Support new-account implementations by aligning procedures, controls, training, reporting, escalation paths, and required approvals âą Gather and validate compliance data, report trends, risks, corrective-action status, and readiness gaps, and maintain secure records and audit trails âą Provide backup support to maintain CX Business Compliance activities and document actions and handoffs
âą Bachelor's degree or an equivalent combination of education and relevant experience âą Nine or more years of experience in healthcare operations, compliance, privacy, quality assurance, risk management, or a related area âą Experience working in a HIPAA-regulated environment and applying privacy, confidentiality, and information-handling requirements âą Experience reviewing business processes, documentation, or operational practices to identify compliance gaps âą Experience writing, developing, and maintaining policies, procedures, SOPs, or other controlled documentation âą Experience translating regulatory, contractual, or company requirements into practical business processes and controls âą Project management experience coordinating initiatives, priorities, and issue resolution across multiple teams or business areas âą Experience analyzing findings, identifying trends or root causes, tracking corrective actions, and communicating risks and recommendations to business leaders âą Proficiency with Microsoft Excel, Word, PowerPoint, and SharePoint âą Experience in Medicaid, healthcare compliance, privacy, provider operations, or member operations âą Experience supporting compliance monitoring, quality reviews, audits, corrective-action programs, or process improvement initiatives across multiple accounts or business areas âą Experience supporting new implementations, operational readiness, policy or SOP governance, training, or leadership reporting âą Familiarity with CXone, Motif, or similar case management, interaction review, verification, or reporting tools âą Compliance, privacy, security, or project management certification such as IAPP CIPP, CIPM, CIPT, PMP, CISA, CISM, or comparable certification
âą Work flexibility âą Learning and career development âą Up to 10% travel opportunity âą Flexible vacation policy âą 401(k) employer match âą Comprehensive health benefits âą Educational assistance âą Leadership and technical development academies
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