Reimbursement Analyst II

🕒 August 25

🇺🇸 United States – Remote

💵 $32.1k - $45.8k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

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

• Perform full claim overpayment analysis • Identify claims paid in error and audit paid claims data using multiple tools and methods • Apply state and federal manuals, regulations, billing policies, and reimbursement practices • Review paid health insurance claims and member eligibility information to identify overpayment trends • Collaborate with data miners, clinical staff, stakeholders, IT resources, internal clients, and management • Use internal and client systems for audit tracking and findings • Organize, document, and communicate audit results • Contribute ideas to improve audit processes and queries • Research client policy and data to identify overpayment recovery opportunities • Assist in identifying new audit concepts • Compile supporting documents, sample claims, and audit approval request forms for client approval • Research industry clinical standards and guidelines • Track and follow up on recoveries • Ensure individual and departmental goals are met or exceeded

🎯 Requirements

• 4-6 years of healthcare reimbursement experience required • Demonstrated experience and knowledge of healthcare claims processing, including Medicaid, Medicare, Commercial Insurance, ICD-9-CM codes, HCPCS codes, CPT codes, DRGs, physician billing, etc. • Experience in healthcare auditing, reviewing and validating claims data and claims payment accuracy preferred • Experience applying CMS regulations and coding guidelines to healthcare claims data; recovery audit experience preferred • Excellent analytical skills required • Excellent time management skills required • Ability to develop, organize, and maintain project plans and agendas • Knowledge of Medicaid, Medicare and Commercial policy and reimbursement or equivalent healthcare experience preferred • Excellent verbal and written communication skills

🏖️ Benefits

• Work flexibility • Learning and career development • Generous, flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies