Senior Healthcare Payment Analyst

Gainwell Technologies LLC • OH

110d • $74,300 - $106,100

About The Position

As an Ideation Analyst - Healthcare Reimbursement 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.

Requirements

• 5+ years of experience in healthcare reimbursement, claims analysis, or revenue cycle improvement.
• Strong background in medical billing/coding, auditing, and provider contract development.
• Familiarity with CMS regulations, coding guidelines, and recovery audit practices.
• Ability to apply published healthcare guidelines to claims data.

Responsibilities

• Develop and implement new data mining opportunities for identifying healthcare overpayments made to providers by insurance companies through data review and analytics.
• Act as a senior member of the team and help to assist lower-level analysts.
• Research industry standard guidelines, State/Federal regulations, and client billing and reimbursement policies, to develop and configure improper payment algorithms.
• Review provider contracts to identify algorithms for the identification of contractual based overpayments.
• Implement current Payment Analytics concepts for new and existing clients by ensuring client policy is supportive and properly applied.
• Support the appeals, validation, and client services team in resolving outstanding issues regarding production queries.
• Ensure individual and departmental goals are consistently met or exceeded, in collaboration with other team members and management.
• Review IT programming results for quality assurance and proof of concept validation.
• Document query results and prepare internal and external documentation and presentations related to new overpayment issues.
• Work with internal operations and clinical teams to develop, implement, review and audit protocols and internal review guidelines.
• Work with engineers to develop and implement technological improvements that will support the audit process.
• Contribute new ideas for improving existing audit processes and audit queries.

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees