Client Services Analyst I, Remote, USA

Freddie Mac; United States; Remote; USD 10,000 - 60,000; Full time

Job summary

Join a leading company as a Client Services Analyst 1, where you'll manage prior authorization and referral requests for Medicaid members. This role offers flexibility, career growth, and a chance to make a difference in healthcare. You'll ensure compliance with industry standards and work with a supportive team dedicated to improving healthcare services.

Benefits

Flexible Vacation

401(k) Match

Health Coverage

Educational Assistance

Qualifications

• Experience in handling prior authorization and referral requests.
• Strong understanding of Medicaid policies is a plus.

Responsibilities

• Process prior authorization and referral requests for Medicaid members.
• Ensure compliance with HIPAA and CMS guidelines.

Skills

Attention to Detail

Critical Thinking

Communication

Tools

Microsoft Excel

Visio

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

We are seeking a talented individual for a Client Services Analyst 1 role, responsible for processing all incoming prior authorization and referral requests involving several state Medicaid members. This includes managing the intake process, referrals, eligibility verification, member demographic review, and other related functions.

Your role in our mission

1. Ensure the correct prior authorization/referral form is completed for the patient's plan. Review medical necessity documents for accuracy, including provider identification, requested procedures, and CPT/Diagnosis codes.
2. Ensure diagnoses, procedures, and services are documented accurately, complying with industry standards and regulations.
3. Validate the appropriateness of requests based on policies, contracts, and medical guidelines, and communicate discrepancies.
4. Monitor processing activities to ensure compliance with legal and regulatory requirements such as HIPAA, CMS guidelines, and contractual obligations.
5. Update systems with patient information to ensure timely claims payment.
6. Achieve quality and productivity KPIs on a daily, monthly, and quarterly basis.
7. Secure patient demographics and medical information, ensuring HIPAA compliance.

What we're looking for

• Experience handling prior authorization and referral requests, medical claims, and member eligibility within healthcare settings.
• Ability to interpret EOBs and claim forms, understanding eligibility, CPT, HCPCS, and service codes.
• Familiarity with insurance payers, benefits, and pre-authorization processes.
• Strong understanding of Medicaid policies is a plus.
• Knowledge of ICD-10, CPT, and HCPCS codes is a plus.
• Strong data entry and documentation skills with attention to detail.
• Critical thinking skills to resolve delays and issues efficiently.
• Excellent communication skills and a professional, positive attitude.
• Availability to work during prior authorization hours (7:00 AM to 6:00 PM Eastern).
• Proficiency with Microsoft Excel, Visio, and PowerPoint.

What you should expect in this role

• Video cameras required during interviews and orientation.
• Full-time (40 hours/week), with possible shift work and extended hours.
• Benefits start on the first day of employment.
• Remote work from any USA location, requiring high-speed internet.
• #LI - REMOTE
• #LI - NA1

The pay range is $20.00 - $25.00/hour, with variations based on location, experience, and skills. Gainwell offers competitive benefits, including flexible vacation, 401(k) match, health coverage, and educational assistance. Join us to grow your career in a company that values flexibility, learning, and development.

We believe in making healthcare better for everyone. Join Gainwell, an industry leader committed to diversity, equity, and inclusion. We are an Equal Opportunity Employer and celebrate diversity in our workplace.