Reference Analyst- Hybrid Williston, VT

Gainwell Technologies LLC•Williston, VT

7d•$43,800 - $62,500•Hybrid

About The Position

As Reference Analyst- Hybrid Williston, VT, 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.

Requirements

Strong oral and written communication skills with the ability to work effectively independently and as part of a team.
Knowledge of Vermont Medicaid policies and proficiency in Professional and Institutional claims billing processes.
Strong attention to detail with the ability to analyze information, prioritize tasks, and make informed decisions.
Ability to manage multiple priorities and competing deadlines while meeting SLA and departmental requirements.
Proficiency in Microsoft Word, Microsoft Excel, and other PC-based systems.

Nice To Haves

CPC certification preferred but not required.

Responsibilities

Liaison with the Department of Vermont Health Access (DVHA) to support coding, pricing, and claims processing reviews.
Update and maintain reference file screens and claims processing system attributes to ensure compliance with Correct Coding requirements.
Set up and maintain relationship and limitation audits as directed by DVHA.
Partner with the Systems team to implement, test, and verify high-volume reference file updates and system changes.
Review claims processing data for compliance, recommend necessary changes, update resolution instructions, and maintain documentation of all system updates.