Carrier Account Manager (Remote in US)

Gainwell Technologies; Town of Texas (WI); Remote; USD 59,000 - 85,000; Full time

Job summary

An established industry player is seeking a Carrier Account Manager to enhance relationships with commercial insurance carriers. This role is pivotal in supporting strategic initiatives and revenue recovery efforts, ensuring a seamless billing and claims process. You will leverage your analytical skills to drive insights from data, collaborate across departments, and foster connections that make a real impact in the healthcare sector. Join a forward-thinking company that values flexibility, learning, and career development while making healthcare work better for everyone. Embrace this opportunity to grow your career in a dynamic environment.

Benefits

Comprehensive health benefits

401(k) employer match

Flexible vacation policy

Company-provided laptop

Educational assistance

Qualifications

• 1-2 years of experience in healthcare, Medicaid/Medicare.
• Strong knowledge of CMS guidelines and Medicaid/Medicare regulations.

Responsibilities

• Manage relationships with commercial insurance carriers.
• Analyze claims data and identify new recovery opportunities.
• Ensure billing cycles are executed and claims are followed through.

Skills

Analytical Skills

Negotiation Skills

Collaboration Abilities

Attention to Detail

Data Analysis

Communication Skills

Education

Bachelor’s degree

Certifications in coding, billing, or practice management

Tools

Microsoft Excel

SQL

Microsoft Access

PowerPoint

Job description

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.

Summary

As a Carrier Account Manager, you will play a key role in managing relationships with commercial insurance carriers and vendors. Your contributions will directly support strategic initiatives and revenue recovery efforts while ensuring a seamless billing and claims process. This is an opportunity to connect your skills with purpose and make a tangible impact in the healthcare space.

Your Role in Our Mission

• Build and maintain strong working relationships with commercial insurance carriers.
• Prepare, track, and manage budgets and revenue expectations for assigned carriers.
• Foster collaboration across departments, especially between the Carrier Relations team and internal stakeholders.
• Provide reporting on strategic carrier growth and identify new business opportunities.
• Maintain consistent communication with multiple payors and vendors.
• Understand and communicate CMS guidelines and State DRA requirements to external partners.
• Oversee platform enhancements, manage billing file updates, and troubleshoot issues related to 835 remits, checks, and EOBs.
• Analyze claims data including procedure codes, bill types, and claim types.
• Identify new recovery opportunities and recommend strategies for increasing revenue.
• Ensure billing cycles are executed, and claims are followed through to remittance.
• Resolve and resubmit denials where appropriate.

What We’re Looking For

• Education: Bachelor’s degree is required.
  • Any additional certifications in coding, billing, or practice management (PM) will be a strong plus.
• 1–2 years of work experience in the healthcare industry, Medicaid/Medicare. Experience developing strategic relationships with multiple insurance payors and carriers.
• Strong attention to detail with excellent negotiation and collaboration abilities.
• Knowledge of Medicaid, Medicare, and CMS regulations. Familiarity with HIPAA privacy and security requirements. Experience working with compliance and legal teams.
• Understanding of the EOB generation process and insurance claim workflows.
• Strong data analysis skills using tools such as Microsoft Excel, Access, SQL, PowerPoint, and company databases. Ability to analyze data sets, identify trends, and perform root cause analysis – Expert Analytical Skills. Exceptional reporting and presentation skills for both internal and external audiences.
• Experience with Anthem Payor and/or Availity Vendor is a significant plus.

What You Should Expect in This Role

• Permanent full-time role (W-2) – not a contract or temporary position.
• Comprehensive benefits including medical, dental, vision, and paid time off – starting on Day 1. Paid time off available after 90-days.
• Company-provided laptop and tools.
• Monday through Friday schedule 8am to 6pm with flexibility to support partners in different time zones.
• Remote work – must reside within the continental U.S.
  • Work environment must be quiet, private, and free of distractions.
  • Reliable high-speed internet: Minimum 24 Mbps download / 8 Mbps upload.
• Cameras must be on during interviews and during the initial week of orientation.
• Important: Applications with placeholder text such as "12345" or "negotiable" in salary fields will not be considered. Please specify your desired salary within the posted range.

This position will remain posted to accumulate applications until May 2, 2025.

The pay range for this position is $59,500.00 - $85,000.00 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 committed to a diverse, equitable, and inclusive workplace. We are proud to be 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), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.