Reimbursement Analyst II (Remote in USA)

Gainwell Technologies; Town of Texas (WI); Remote; USD 80,000 - 100,000; Full time

Job summary

An established industry player is seeking a Reimbursement Analyst II to join their dynamic team. This remote role involves analyzing healthcare claims to identify overpayments, collaborating with various stakeholders, and contributing to process improvements. The ideal candidate will possess strong communication skills and a solid background in healthcare reimbursement, ensuring that the organization meets its goals while enhancing the overall healthcare experience. With comprehensive benefits and a commitment to career growth, this position offers an exciting opportunity to make a meaningful impact in the healthcare sector.

Benefits

Flexible vacation

401(k) match

Development programs

Qualifications

• 4-6 years of experience in healthcare reimbursement and claims analysis.
• Knowledge of Medicaid, Medicare, and Commercial policies preferred.

Responsibilities

• Analyze claims for overpayment and assist in audits.
• Collaborate with stakeholders to identify overpayment trends.

Skills

Healthcare reimbursement experience

Claims analysis

Medical billing/coding

Claims auditing

Revenue cycle improvement

Project management

Communication skills

Job description

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Reimbursement Analyst II (Remote in USA)

Date: Apr 24, 2025

Location: Any city, TX, US, 99999

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 offers rewards including career growth opportunities, work flexibility, learning, and development.

Summary

Seeking a talented individual responsible for full claim overpayment analysis. Assists with identifying claims paid in error and audits paid claims data using multiple tools and methods, referencing state and federal manuals/regulations, billing and reimbursement policies, and system edits.

Your role in our mission:

• Utilizes CMS, State, and Client billing and reimbursement policies, reviewing manuals/regulations and meeting with stakeholders to identify claim overpayments with limited oversight.
• Reviews paid health insurance claims and member eligibility to uncover overpayment trends.
• Works with data miners, clinical staff, and stakeholders to identify overpaid claims, using internal and client systems for audit tracking and findings.
• Organizes, documents, and communicates results; collaborates with IT resources as needed.
• Ensures departmental goals are met or exceeded, collaborating with team members and management.
• Contributes ideas to improve audit processes and queries, working with the ideation team and clients.
• Provides feedback for trending provider billing and claims processing, researching client policies to identify recovery opportunities.
• Assists in developing new audit concepts, compiling supporting documents and audit approval requests for client approval.
• Research industry standards and guidelines.
• Tracks and follows up on recoveries.
• Maintains excellent verbal and written communication skills.

What we're looking for

• 4-6 years of healthcare reimbursement experience, including provider contract development, claims analysis, medical billing/coding, patient accounting, claims auditing, or revenue cycle improvement.
• Knowledge of healthcare claims processing (Medicaid, Medicare, Commercial Insurance), ICD-9-CM, HCPCS, CPT codes, DRGs, physician billing, etc.
• Experience in healthcare auditing and claims validation preferred.
• Ability to develop and maintain project plans.
• Knowledge of Medicaid, Medicare, and Commercial policies or similar healthcare experience preferred.

What should you expect in this role

• Remote work across all USA locations.
• Position code: #LINA1

The pay range is $17.00 - $29.00/hour, with variations based on region, experience, and other factors. Gainwell offers comprehensive benefits, flexible vacation, 401(k) match, and development programs. Join us to make healthcare better for everyone. Learn more at our website and careers page.

Gainwell Technologies is committed to diversity, equity, and inclusion. We are an Equal Opportunity Employer, celebrating diversity and creating an inclusive environment for all employees.