Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary

As a Carrier and Vendor Relations Manager at Gainwell, you will be a part of an innovative healthcare technology company with a mission to serve the healthcare needs of our communities. You will use your network testing and network management skills to drive the development of healthcare administration products used, and relied upon, by millions of patients. Most importantly, you’ll have the chance to grow and develop as a professional through our exceptional developmental opportunities. 

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Your role in our mission 

• Understand and Build relationships with commercial insurance carriers.
• Prepares, monitors, and manages budget and revenue expectations for all assigned carriers.
• Establish and nurture relationships with health industry payment solutions vendors.
• Take charge of securing new contracts to expand relationships with Insurance Carriers and Payment Vendors, such as Zelis, ECHO, Instamed, SDS, Payspan, Vpay, Optum, and Change Healthcare
• Foster collaboration between the Carrier Relations team and all other Gainwell departments.
• Report progress towards strategic carrier growth and identify opportunities to management.
• Present business reviews on progress against team goals/objectives and strategic plans.
• 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.
• Resolve and work assigned projects.
• Determine the best course of action to ensure claims processing and payments are accurately recorded in our Account Receivable system..
• Manage reporting and forecasts for the carrier portfolio, presenting trends, forecast analysis, and planning strategies to Gainwell and carrier management teams.
• 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.
• Determines best course of action for all unprocessed claims.

What we're looking for 

• 2+ years related work experience, with Knowledge of Medicaid and Medicare.
• Experience in developing strategic account and vendor relationships.
• Detail-orientation with excellent negotiation and collaboration skills.
• Strong understanding of how EFT and Payment Processor Vendors operate in the Health Industry.
• Proficiency in data analysis using Microsoft Excel, Word, Access, PowerPoint, SQL, Micro Strategies, and company databases.

What you should expect in this role

• Opportunities to travel through your work (0-10%)
• Fully remote opportunity with the option to work anywhere within the United States
• The deadline to submit applications for this posting is 4/30/2024.

#LI-REMOTE

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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.