Reimbursement Analyst

🕒 August 25

🇺🇸 United States – Remote

💵 $34.3k - $49k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

🦅 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

• Analyze healthcare claims using CMS, state, client, and payer reimbursement policies, regulations, and billing guidelines to identify overpayments and recovery opportunities • Review paid claims and member eligibility data to identify overpayment trends, patterns, and potential audit opportunities • Collaborate with data analysts, clinical teams, IT resources, and business stakeholders to identify, validate, and recover overpaid claims • Maintain audit documentation, track findings, and communicate results to internal and external stakeholders • Achieve individual and team performance goals while supporting departmental objectives • Recommend and implement enhancements to audit processes, methodologies, and data queries • Research provider billing practices, claims processing trends, and reimbursement policies to uncover recovery opportunities • Assist in developing and evaluating audit concepts and payment integrity initiatives • Prepare supporting documentation, sample claims, and audit approval materials for client review and implementation • Research and apply industry standards, clinical guidelines, and regulatory requirements to support audit activities • Monitor recovery efforts through resolution • Prepare reports, metrics, and tracking tools to support team performance and operational objectives

🎯 Requirements

• High school diploma or GED required; bachelor’s degree preferred • 4-6 years of healthcare reimbursement experience, including provider contract development, healthcare claims analysis, medical billing/coding, patient accounting, claims auditing, and/or revenue cycle improvement • Demonstrated experience and knowledge of healthcare claims processing for Medicaid, Medicare, and Commercial Insurance • Knowledge of ICD-9-CM codes, HCPCS codes, CPT codes, DRGs, physician billing, and related claims-processing concepts • Experience in healthcare auditing and reviewing and validating claims data and claims payment accuracy preferred • Experience applying published healthcare guidelines, including CMS regulations and coding guidelines, to healthcare claims data • Recovery audit experience preferred • Strong analytical, organizational, verbal, and written communication skills • Ability to work collaboratively in a team-oriented environment

🏖️ Benefits

• Work flexibility • Learning and career development • Fully remote work environment • Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies