Carrier Account Manager

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 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. Here are the details on this position.

Essential Job Functions

• Understand and Build relationships with commercial insurance carriers.
• Prepares, monitors, and manages budget and revenue expectations for all assigned carriers.
• Foster collaboration between the Carrier Relations team and all other Gainwell departments.
• Report progress towards strategic carrier growth and identify opportunities to management.
• Coordinate, conduct, and maintain regular communication with multiple health insurance payors and vendors.
• Understand CMS guidelines and State DRA’s, articulating them effectively with carrier and vendor contacts.
• Oversee platform enhancements and manage billing file fixes, 835 remits, checks, and Explanation of Benefits.
• Analyze claims data, procedure codes, bill types, and claims types.
• Identify and continually seek new sources of recoveries, recommending and presenting strategies for increased recoveries or new revenue opportunities.
• Manage the carrier billing process, ensuring cycles are completed and accepted by carriers. Follow claims through the carrier payment processes to receipt of remittances.
• Oversees platform enhancements and billing file fixes/updates.
• Resolves and reworks any denials that can be resubmitted.

Basic Qualifications

• Experience in developing strategic relationships with multiple payors and insurance carriers
• Detail orientation with excellent negotiation and collaboration skills.
• Knowledge of Medicaid and Medicare.
• Working understanding of HIPAA privacy and security rules.
• Experience working with compliance and legal departments.
• Familiarity with the Health insurance Explanation of Benefits (EOB) generation process.
• Proficiency in data analysis using Microsoft Excel, Word, Access, PowerPoint, SQL, Micro Strategies, and company databases.
• Ability to analyze data, pose data-related questions and perform root cause analysis.

Work Environment

• Fully remote opportunity with the option to work from anywhere within the United States.

The deadline to submit applications for this posting is 11/22/2024.

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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.