Carrier Account Manager (Remote in USA)

Gainwell Technologies LLC

78d • Remote

About The Position

As a Carrier Account Manager at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.

Requirements

• Experience in developing strategic relationships with multiple payors and insurance carriers with excellent negotiation and collaboration skills.
• Knowledge of Medicaid and Medicare and working understanding of HIPAA privacy and security rules.
• Experience working with compliance and legal departments.
• Familiarity with the Health insurance Explanation of Benefits (EOB) generation process.
• Proficiency in data analysis using Microsoft Excel, Word, Access, PowerPoint, SQL, Micro Strategies, and company databases to pose data-related questions and perform root cause analysis.

Responsibilities

• Understand and Build relationships with commercial insurance carriers.
• Prepares, monitors, and manages budget and revenue expectations for all assigned carriers.
• Foster collaboration between the Carrier Relations team and all other Gainwell departments.
• Report progress towards strategic carrier growth and identify opportunities to management.
• Coordinate, conduct, and maintain regular communication with multiple health insurance payors and vendors.
• Understand CMS guidelines and State DRA’s, articulating them effectively with carrier and vendor contacts.
• Oversee platform enhancements and manage billing file fixes, 835 remits, checks, and Explanation of Benefits.
• Analyze claims data, procedure codes, bill types, and claim types.
• Identify and continually seek new sources of recoveries, recommending and presenting strategies for increased recoveries or new revenue opportunities.
• Manage the carrier billing process, ensuring cycles are completed and accepted by carriers. Follow claims through the carrier payment processes to receipt of remittances.
• Oversees platform enhancements and billing file fixes/updates.
• Resolves and reworks any denials that can be resubmitted.

Benefits

• Health benefits (medical, dental, vision) and paid time off benefits start on day 1 of employment.
• Company match 401K and other benefits available within months of starting.
• New employees are eligible to take advantage of flexible vacation policy after ninety (90) calendar days of employment.
• Company provided computer.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed