Business Analyst – Pharmacy Benefit Management

by Irma Moore | Mar 4, 2024 | Uncategorized

Summary

As a Business Analyst – Pharmacy Benefit Management 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. You will coordinate testing for the Pharmacy Benefit Management System (PBMS), Colorado interchange and relevant subsystems related to the PBMS implementation.  Also, serves as the liaison between the Department, Gainwell staff, and other contractor staff to translate new or revised processes, and coordinates with other sections in the Department to implement the Pharmacy Benefit Management System (PBMS). Here are the details on this position.

Your role in our mission

Gainwell empowers you show you’re a pro and help clients deliver better health and human services outcomes using innovative technology and solutions.

• Identifies, initiates and assures the quality of system functionality and change/enhancement projects in Interchange related to the Pharmacy Benefit Management System (PBMS) implementation, including as applicable all claims and capitation related system changes, pricing, benefit plans, reference codes, and interface file exchanges.  
• Drafting configuration change management (CCM) documents and reviewing test cases on a large scale related to the PBMS implementation. 
• Coordinates with pharmacy staff related to designing or enhancing systems, diagnosing system issues, analyzing test results, and coordinating system procedures in the Interchange related to the PMBS implementation
• Draft system requirements for new and revised processes to integrate the new PBMS and programs into the Interchange and collaborate with other system analysts and vendors in the development, validation process and review of technical specifications.  
• Review test plans, technical specifications, test results and provide system documentation for new and revised processes. 
• Assures Interchange changes align with the PBMS implementation and maintains a system of checks and balances to assure that data is consistent, complete and accurate
• Researches testing topics and validates that test results meet the identified functional requirements.  
• Coordinates with program staff and system staff to review test results to ensure that the Interchange functions as intended.  
• Analyze test results for defect findings and define the remediation process for the test environment while working within Gainwell to ensure that the defects are corrected, fully retested and approved for production
• Provide status report on testing to relevant staff and vendors. 

What we’re looking for

• Three or more years of Business Analyst Experience, with 1 or more years of Medicaid preferred.
• Prior Pharmacy Benefit Management System (PBMS) experience preferred.
• Advanced knowledge in Microsoft Excel and other software for conducting quantitative analysis. SQL experience is a plus
• Ability to create and document test scenarios according to the business requirements. Providing support with end user testing as needed. 
• Strong analytical and business process re-engineering skill
• Strong written and oral communication and presentation skills to work with providers and managed care organizations related to claim submission in the Interchange and PBMS. 

What you should expect in this role

• Fully remote options from most US locations and territories
• This position supports the state of Colorado, working hours will correspond to mountain time zone.
• Video cameras must be used during all interviews, as well as during the initial week of orientation

#LI-HC1

#LI-Pharmacy Benefit Management

#LI-Microsoft Office suite

The pay range for this position is $55,600.00 – $79,400.00 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.Apply Now 

Accounts Payable & Receivable Coordinator

by Irma Moore | Mar 4, 2024 | Uncategorized

Win Brands Group has recently become aware of the fraudulent use of our name on job postings and via recruiting emails that are illegitimate and not in any way associated with us. 

Win will never ask you to provide sensitive personal information as part of the recruiting process, such as your social security number; send you any unsolicited job offers or employment contracts; require any fees, payments or access to any financial accounts; and/or conduct text-only interviews.  

If you suspect you are being scammed or have been scammed online, you may report the crime to the Federal Bureau of Investigation and obtain more information regarding online scams at the Federal Trade Commission. If you have questions about the authenticity of any communication sent purportedly by or on behalf of Win, we encourage you to contact us here.

About the Opportunity

We are looking for a skilled Accounts Payable & Receivable Coordinator that is responsible for processing all invoices received for payment and for undertaking the payment of all creditors in an accurate, efficient, and timely manner. Additionally, the Accounts Payable & Receivable Coordinator will ensure the accuracy and efficiency of operations, processing and monitoring incoming payments, and securing revenue by verifying and posting receipts. This role will report to our Accounting Manager and can be based anywhere in the US.

What You’ll Do

• Process outgoing and incoming payments in compliance with financial policies and procedures
• Perform day to day financial transactions, including verifying, classifying, computing, posting, and recording accounts payable and receivables’ data
• Prepare bills, invoices, and bank deposits
• Reconcile the accounts receivable and accounts payable ledgers to ensure that all payments are accounted for and properly posted. Actively following up on aged receivables and inquiring about collection
• Facilitate payment of invoices due by sending bill reminders and contacting clients
• Generate financial statements and reports detailing accounts payable and receivable status
• Verify and investigate discrepancies, if any, by reconciling vendor accounts and monthly vendor statements
• Resolve any clients’ billing issues, once a discrepancy has been verified
• Own the AR collections process
• Understand expense accounts and cost centers
• Understands compliance issues around accounts payable processes (W-9, sales tax, etc.)

What You’ll Bring

• Solid understanding of basic bookkeeping, accounting principles, fair credit practices, and collection regulations
• Proven ability to calculate, post, and manage accounting figures and financial records
• Data entry skills along with a knack for numbers
• Hands-on experience in operating spreadsheets and accounting software 
• Experience with third party payment processors
• Proficiency in English and in MS Office
• Customer service orientation and negotiation skills
• A high degree of accuracy and attention to detail
• 2+ years of relevant experience 
• Experience using QuickBooks and Netsuite is preferred
• BS degree in Finance, Accounting or Business Administration is preferred, but not required

Remote Patient Billing Representative

by Irma Moore | Mar 4, 2024 | Uncategorized

Responsibilities

In this Job you will:

• Researches, resolves, and documents patient inbound and outbound calls involving a wide range of issues utilizing multiple information systems. This includes communications with internal business centers and external customers. Assures customer agreement by summarizing and closing each call appropriately.
• Investigates payment status and determines ultimate patient financial responsibility.
• Collect outstanding balance, offer patient assistance with financial responsibility through various financial options.
• Maintains patient confidentiality and data integrity in accordance with Health Information Portability Accountability Act (HIPAA), and company policies and procedures.
• Exercises good judgment, interpret data, and remains knowledgeable in details of all related CareCentrix contracts, policies and procedures. Participates in process improvement initiatives; maintains teamwork, customer service production and quality standards to assure timely, efficient and accurate call resolution.
• Minimize patient dissatisfaction with active listening, maintaining a professional tone, and acknowledging their concerns.

This job is for you if:

• You are passionate about health care and believe that one of the best ways to do that is by helping improve the quality and access to care in the home.
• You enjoy working in a fast-paced environment
• You are accurate with strong attention to detail
• You have the ability to communicate professionally
• You are fun to work with!  We take our commitment to patients seriously, but we don’t take ourselves seriously.  We are looking for team members who bring joy to the work they do.

Qualifications

You should get in touch if you have:

• High School Diploma or GED.
• Minimum 1 year work experience in a call center environment (billing experience preferred)
• Good computer skills
• Great communication and problem solving skills – Embracing the values of accountability, consistency and engagement through excellent attendance
• Excellent customer service through the ability to care for others – Flexibility, adaptability and motivation learn

What we offer:

• Starting Pay for external hires is $17.50 / hour + Incentive Bonus Opportunity.  The pay range included in this posting reflects future growth / earning potential.
• Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.
• Profit Sharing, generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more.
• Advancement opportunities, professional skills training, and tuition Reimbursement
• Great culture with a sense of community.

Remote Revenue Cycle A/R Representative

by Irma Moore | Mar 4, 2024 | Uncategorized

Are you interested in remote work with a flexible schedule? The Virtual Business Office supports some of the largest hospitals in the country and is known as an award-winning extended business office. We are looking for talented and highly motivated revenue cycle professionals to join our A/R Follow-up and Denials Management team.

Why Join Us?

• Our team is fully remote with no plans to return to office and hiring across the southeast in NC, SC, GA, FL, AL, TX, KY, VA, and TN.
• You’ll support one of the largest professional services firms in the world, with access to cutting edge automation and AI technologies to enhance your workday experience
• A flexible schedule that allows you to enjoy a work-life balance. With core business hours from 9:00am-3:00pm EST, you have flexibility with clocking in and out, along with the ability to work half-days on Friday’s
• We hire you directly and offer a comprehensive employee benefits package to include major health coverage, 401k, PTO accrual, and more!
• Endless growth opportunities and continuous professional development
• Opportunity to participate in our “VIP” bonus structure for outstanding performance and “Real time Recognition” incentives

What you’ll do

• Utilize and apply industry knowledge to resolve new and aged accounts receivables by working various account types, including but not limited to: hospital and/or professional claims, governmental and/or non-governmental claims, denial claims, high priority accounts, high dollar accounts, reimbursements, credits, etc
• Communicate professionally (in all forms) with payer resources to include: websites/payer portals, e-mail, telephone, customer service departments, etc
• Seek resolution to problematic accounts and payment discrepancies
• Prepare appeal letters for technical denials by accessing specific payer appeal forms, submitting appropriate medical documentation, and tracking appeal resolution
• Identify denials trends, root cause, and A/R impact
• Maintain professional communication with clients and team members through various channels
• Consistently meet or exceed department standards and guidelines
• Adhere to the HIPAA privacy and security regulations

What you’ll need

• GED or High School Diploma
• 3+ years of experience in Medical Collections, back-end A/R, and claim review in which denial follow up was worked
• Experience in Hospital, Professional/Physician, and /or Third-Party billing and accounts receivable
• Epic, or relevant EMR system experience

Bill Review Analyst

by Irma Moore | Mar 4, 2024 | Uncategorized

Bill Review Analyst, you would be responsible for identifying unbundled charges and billing errors through pre-screening of claims. Your findings will be used by our negotiation team to help them achieve better results during the negotiation process. You will also carry out in-depth reviews based on accepted billing practices and coding rules. 

To achieve the best results, you will need to maintain excellent communication with both internal teams and management. Your efforts will result in significant savings for our clients. 

Are you looking for a new challenge and the chance to develop your skills? Apply now and don’t miss out on this exciting opportunity!

DUTIES AND RESPONSIBILITIES: 

• Identifies correct billing and savings on claims by running the codes through the system programs.
• Performs research on fee schedule states in the auditing process.
• Maintains a functional understanding of Workers’ Compensation state fee schedules, billing and coding rules and state specific provider payment regulations.
• Works collaboratively with the Negotiations team to resolve claim issues and obtain additional discount.
• Assists the Negotiation team with provider communication, obtaining a corrected claim or letter of agreement, based on audit findings and financial benchmarks.
• Communicates all findings to the Negotiation team by providing a Bill Analysis report/email.
• Communicates with the negotiation team, to query or to resolve billing discrepancies.
• Maintains a consistent department bill review prescreen turnaround time. Standard TAT for Bill Analyst prescreen 24-48 hours from UB/IB receipt.
• Complies with/supports HIPAA standards.
• Identifies system/process issues and seeks interdepartmental resolutions.
• Understanding of medical terminology and guidelines for medical services, charges, etc.; ability to read and understand medical bills and records.
• Ability to collect and organize data, identify and define issues, organize and communicate facts using concise business writing.
• Ability to make prompt, intelligent decisions based upon detailed analysis of issues including accurate and valid conclusions.
• Ability to handle a variety of instructions and priorities.

OTHER DUTIES:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.



POSITION REQUIREMENTS:

• Great Attention to Detail is a must.
• Excellent Organization Skills.
• Must be able to work independently.
• Excellent communication skills, both verbal and written.
• Dependability
• 1-3 years of auditing, claims, review and/or billing experience with a healthcare organization required.  Workers’ Compensation experience preferred.
• Bill and concurrent review experience.
• DRG Validation experience.
• Line Charge Verification experience.
• CPC and CIC certifications preferred.
• Working knowledge of industry coding, ICD-10, CPT, HCPCS Revenue codes etc.
• Has experience with Microsoft Office applications.
• Working knowledge of Health Insurance, Medicare guidelines and various healthcare programs
• Knowledge of CMS guidelines.

Benefits:

• Medical, Rx, and Wellness Benefits
• Dental and Vision Plan Options
• Short-term Disability
• 401(k) Retirement Plan
• Holiday Pay

Compensation / Pay Rate (Up to): $60,000.00 – $65,000.00 Per Year