Provider Service Analyst, Medicaid, Remote, Local in New Mexico, USA

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.

Summary

We are seeking a talented individual for a Provider Services Analyst - Medicaid who provides on-site and remote account analysis for identifying and recovering client overpayments made to healthcare providers. Responsible for provider outreach and scheduling on-site reviews. Responsible for developing and managing Provider relationships, working independently to identify and secure Provider refunds. Explains audit policies and procedures to the provider; conducts exit conferences to review findings, and reschedules subsequent audits. Responsible for providing successful field and remote performance within assigned territory.

Your role in our mission

• Provides on-site and remote financial account analysis; analyzes the following situations to identify instances of overpayments and clarifies discrepancies:
• Payment received by more than one payor
• Retroactive payments
• Double billing/payments
• Inaccurate postings
• Charges written off in excess of amounts actually billed
• Debit contractual adjustments
• Reclassification of accounts
• Charges removed
• Provider A/R collection systems modeling net revenue at the time of billing
• Incorrect coordination of benefits
• Payments made outside of payer specific guidelines/parameters ? Analyzes provider Aged Trial Balance and Debit Adjustment reports and ? determines what claims will be reviewed during audit.
• Schedules, provides follow up and communication with provider personnel throughout duration of review.
• Identifies refund trends that can be applied across contract base to maximize revenue and makes recommendation for data mining projects.
• Provides credit balance worksheets and/or summary reports for each review conducted to providers and internal staff, as required.

What we're looking for

• 3 years of healthcare billing experience, audit or collection and accounts receivable experience in a healthcare environment preferred, but not required
• Ability to function effectively under pressure and deadline oriented project demands as well as manage multiple initiatives.
• Ability to analyze information, use logic and processes to overcome obstacles and resolve problems.
• Ability to multi-task, establish priorities, and work independently to meet objectives.
• Ability to work proficiently with Microsoft Word and Excel.
• Ability to quickly gain a sound foundation of knowledge of the various major provider accounts receivable systems.
• Ability to work effectively in both team and independent environments.
• Ability to follow instructions and established work protocols. Ability to organize well.
• Ability to be versatile and easily adaptable to new regulations and rules from client to client.
• Ability to assimilate to diverse national payer standards, per client needs.
• Ability to remain knowledgeable of current payer specific reimbursement regulations and remain abreast of changes to policy through client websites, etc.
• Ability to be detail oriented and quality focused.
• Ability to adhere to corporate policies and guidelines concerning audit protocol and adherence to HIPAA guidelines.
• Ability to maintain and enhance existing customer relationships
• Healthcare reimbursement or claim knowledge
• Understanding of coordination of benefit rules
• Understanding of healthcare claim billing and collection terminology
• May be required to work extended hours for special business needs
• May be required to travel at least 25% of time based on business needs; at times on short notice

What should you expect in this role

• Remote in New Mexico, USA
• #LI-NA1
• #Remote-New Mexico

The pay range for this position is $35,200.00 - $50,300.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. 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.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

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