Client Services Analyst I, Remote, USA

Gainwell Technologies

245d • $20 - $25 • Remote

About The Position

We are seeking a talented individual for a Client Services Analyst 1 who is responsible for processing all incoming prior authorization and referral requests involving several state Medicaid members. This includes managing the intake process, referrals, eligibility verification, member demographic review and other related functions to the prior authorization or referral requests.

Requirements

• Must have experience handling prior authorization requests and referral requests (intake), medical claims, member eligibility within a healthcare setting.
• Demonstrated ability to interpret an Explanation of Benefits (EOB) and UB-04 claim form required i.e., eligibility, CPT, HCPCS, DRx codes and service types.
• Familiarity with insurance payers, medical benefits, and pre-authorization processes for various healthcare services.
• Must have strong understanding of Medicaid policies is a plus.
• Knowledge of ICD-10, CPT, and HCPCS codes is a plus.
• Strong data entry and documentation skills with attention to detail is required.
• Critical thinking skills to identify potential delays and resolve issues efficiently.
• Strong attention to data quality with a focus on data reconciliation between sources or platforms.
• Strong communication skills, a positive attitude, and a friendly and professional approach to customers.
• Candidates must be able to work during the prior authorization hours of 7:00 AM to 6:00 PM Eastern.
• Ability to work proficiently with Microsoft Excel, Visio, PowerPoint.

Responsibilities

• Ensures correct prior authorization/referral form is completed for patient's plan.
• Reviews medical necessity documents for accurate information to include patient provider identification information, clinic or procedure requested, and appropriate CPT/Diagnosis codes to verify the accuracy and completeness of information submitted by healthcare providers.
• Validates the appropriateness of prior authorization requests and referrals based on established policies, contracts, and medical guidelines.
• Identifies discrepancies or inconsistencies and appropriately communicate them for further investigation.
• Monitors prior authorization requests and referrals processing activities to ensure adherence to legal and regulatory requirements, such as HIPAA, CMS guidelines, and contractual obligations.
• Updates systems with patient information and actions to ensure timely claims payment.
• Achieves daily, monthly, and quarterly quality and productivity KPIs.
• Secures patient demographics and medical information, ensuring HIPPA compliance.

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Professional, Scientific, and Technical Services