Carrier Account Manager (Remote in US)

Gainwell Technologies-posted 7 months ago
$59,500 - $85,000/Yr
Full-time • Entry Level
Remote
Professional, Scientific, and Technical Services
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As a Carrier Account Manager, you will play a key role in managing relationships with commercial insurance carriers and vendors. Your contributions will directly support strategic initiatives and revenue recovery efforts while ensuring a seamless billing and claims process. This is an opportunity to connect your skills with purpose and make a tangible impact in the healthcare space.

  • Build and maintain strong working relationships with commercial insurance carriers.
  • Prepare, track, and manage budgets and revenue expectations for assigned carriers.
  • Foster collaboration across departments, especially between the Carrier Relations team and internal stakeholders.
  • Provide reporting on strategic carrier growth and identify new business opportunities.
  • Maintain consistent communication with multiple payors and vendors.
  • Understand and communicate CMS guidelines and State DRA requirements to external partners.
  • Oversee platform enhancements, manage billing file updates, and troubleshoot issues related to 835 remits, checks, and EOBs.
  • Analyze claims data including procedure codes, bill types, and claim types.
  • Identify new recovery opportunities and recommend strategies for increasing revenue.
  • Ensure billing cycles are executed, and claims are followed through to remittance.
  • Resolve and resubmit denials where appropriate.
  • Bachelor's degree is required.
  • 1-2 years of work experience in the healthcare industry, Medicaid/Medicare.
  • Experience developing strategic relationships with multiple insurance payors and carriers.
  • Strong attention to detail with excellent negotiation and collaboration abilities.
  • Knowledge of Medicaid, Medicare, and CMS regulations.
  • Familiarity with HIPAA privacy and security requirements.
  • Experience working with compliance and legal teams.
  • Understanding of the EOB generation process and insurance claim workflows.
  • Strong data analysis skills using tools such as Microsoft Excel, Access, SQL, PowerPoint, and company databases.
  • Ability to analyze data sets, identify trends, and perform root cause analysis.
  • Exceptional reporting and presentation skills for both internal and external audiences.
  • Any additional certifications in coding, billing, or practice management (PM) will be a strong plus.
  • Experience with Anthem Payor and/or Availity Vendor is a significant plus.
  • Comprehensive benefits including medical, dental, vision, and paid time off - starting on Day 1.
  • Paid time off available after 90-days.
  • Company-provided laptop and tools.
  • Flexible schedule to support partners in different time zones.
  • Generous, flexible vacation policy.
  • 401(k) employer match.
  • Educational assistance.
  • Leadership and technical development academies.
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