Early Career Business Analyst - Operations

Gainwell Technologies LLC•Any city, OH

3d•$44,500 - $63,500•Remote

About The Position

HMS, a Gainwell Company, is seeking a detail-oriented Operations Business Analyst to support healthcare claims payment operations. The role handles daily posting of medical and pharmacy payments to claims using paper and electronic Explanation of Benefits (EOBs), accounts receivable reconciliation, correction of posting errors, and monthly invoicing for claims processed during the reporting period. The analyst also supports requirements gathering and documentation, business process analysis and improvement, systems requirements documentation, and collaboration with client engagement and technical personnel. The position requires familiarity with healthcare claims and payment processes, including medical and pharmacy claims adjudication and Medicaid reclamation. The analyst will use SQL and relational databases to extract and analyze information, PeopleSoft Finance or a similar financial system to generate invoices, and FTP protocols to securely transfer files. The role includes producing and analyzing posting and reconciliation reports, maintaining audit and compliance documentation, resolving payment issues with other departments, and meeting deadlines and service level agreements while working independently. The position offers fully remote work from locations in the contiguous United States. Video is required during interviews and the initial week of orientation.

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, including the 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 daily using paper and electronic EOBs.
Reconcile accounts receivable and correct discrepancies or posting issues.
Identify, analyze, and resolve claim posting and payment errors.
Participate in client engagement meetings to gather and document requirements and explore solutions.
Assist with analysis and documentation of client business requirements and processes, and communicate requirements to technical personnel.
Plan and design standard business processes and assist in recommending improvements to 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.