Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You'll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.
SummaryAs a
Senior Business Analyst - Medicaid 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. Here are the details on this position.
Your role in our mission - Lead requirements elicitation sessions with business stakeholders and technical teams.
- Analyze and document current-state and future-state processes for Medicare and Medicaid claims.Serve as a subject matter expert (SME) on CMS guidelines, state Medicaid rules, and claims adjudication workflows.
- Develop detailed business and functional requirements for system enhancements and integrations.
- Partner with IT teams to design solutions and validate technical feasibility.
- Oversee User Acceptance Testing (UAT) and ensure quality deliverables.Monitor KPIs such as claim turnaround time, denial rates, and compliance adherence.
- Provide guidance and mentorship to junior analysts.
- Prepare executive-level reports and presentations on claims performance and regulatory compliance.
What we're looking for - Bachelor's degree in Healthcare Administration, Business, or related field (Master's preferred).
- 5+ years of experience in healthcare claims analysis, with strong Medicare/Medicaid expertise.
- In-depth knowledge of CMS regulations, HIPAA compliance, and state-specific Medicaid requirements.
- Hands-on experience with claims adjudication systems (Facets, QNXT, or similar).
- Strong analytical and problem-solving skills with proficiency in SQL and data visualization tools (Power BI, Tableau).
- Excellent communication and stakeholder management skills.
Preferred Skills - Experience in Agile methodology and healthcare IT projects.
- Familiarity with EDI transactions (837, 835) and ICD/CPT coding.
- Ability to lead cross-functional teams and manage multiple priorities.
What you should expect in this role - Fully remote options from continental US locations only
- Video cameras must be used during all interviews, as well as during the initial week of orientation
- The deadline to submit applications for this posting has been extended until a suitable candidate has been selected
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The pay range for this position is $64,900.00 - $92,700.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
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