Early Career Business Analyst - Operations

Gainwell Technologies LLC•Any city, OH

2d•$44,500 - $63,500•Remote

About The Position

HMS, a Gainwell Company, is seeking a detail-oriented Operations Business Analyst to support daily medical and pharmacy claims payment posting and accounts receivable reconciliation. The analyst processes paper and electronic Explanation of Benefits (EOBs), resolves posting errors and discrepancies, and generates monthly invoices based on claims processed during the reporting period. The role also involves gathering and documenting client requirements, analyzing business processes, preparing systems requirements documentation, and recommending process improvements. The analyst creates and analyzes reports, securely transfers files, maintains audit and compliance documentation, and collaborates across departments to address claims and payment issues. The position requires independent work in a remote environment while meeting deadlines and service level agreements. Remote work is available from locations in the contiguous United States only.

Requirements

Bachelor’s degree in Business, Healthcare Administration, Finance, or a related field, or 3–5 years of experience in medical claims posting and reconciliation.
Solid understanding of medical and pharmacy claims adjudication and Medicaid reclamation claims.
Proficiency in SQL and ability to extract and analyze data from relational databases.
Familiarity with PeopleSoft Finance or similar enterprise financial systems.
Strong critical-thinking and problem-solving skills, with ability to troubleshoot independently.
Experience with FTP protocols and secure file transfer.
Excellent written and verbal communication skills.

Nice To Haves

Experience working with healthcare data analytics or reporting tools.
Prior experience in a remote or hybrid work environment.
Knowledge of healthcare payment cycles and insurance reimbursement processes.

Responsibilities

Post payments to medical and pharmacy claims from paper and electronic EOBs daily.
Reconcile accounts receivable and correct discrepancies or posting issues.
Identify, analyze, and resolve errors in claim postings and payments.
Participate in client engagement meetings to gather and document requirements and explore potential solutions.
Assist in analyzing and documenting client business requirements and processes, and communicate requirements to technical personnel.
Plan and design standard business processes and assist in formulating recommendations to improve and support business activities.
Develop and modify systems requirements documentation to meet client needs.
Generate and distribute monthly invoices in PeopleSoft Finance based on claims posted during the reporting period.
Create, run, and deliver posting and reconciliation reports, and analyze trends and anomalies.
Use FTP protocols to securely transfer files from various sources.
Maintain accurate documentation for audit and compliance purposes.
Collaborate with other departments to resolve claims and payment issues.
Work independently in a remote environment while meeting deadlines and service level agreements.