Reference Analyst — Hybrid/Remote Health Claims

Gainwell Technologies; Williston (VT); Hybrid; USD 44,000 - 63,000; Full time

Benefits offered by this job

Flexible vacation policy

401(k) employer match

Comprehensive health benefits

Job summary

Gainwell Technologies in Williston, Vermont, is seeking a Reference Analyst for a hybrid role to support DVHA through coding, pricing, and claims processing reviews. This position emphasizes accuracy, adherence to Correct Coding rules, and proactive data management.

You will collaborate with systems and health-policy teams, update reference file attributes, and maintain auditable documentation while supporting multiple priorities and deadlines in a dynamic health-services environment.

Qualifications

• Strong communication skills, able to work independently and in a team.
• Knowledge of Vermont Medicaid policies and billing processes.
• Attention to detail with ability to analyze information and prioritize.
• Ability to manage multiple priorities and meet deadlines.
• Proficiency in Word and Excel; CPC certification preferred.

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.

Skills

Communication

Medicaid knowledge

Microsoft Word

Microsoft Excel

CPC certification

Job description

Gainwell Technologies in Williston, Vermont, is seeking a Reference Analyst for a hybrid role to support DVHA through coding, pricing, and claims processing reviews. This position emphasizes accuracy, adherence to Correct Coding rules, and proactive data management.

You will collaborate with systems and health-policy teams, update reference file attributes, and maintain auditable documentation while supporting multiple priorities and deadlines in a dynamic health-services environment.