Client Services Analyst I (Fully Remote - USA)

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
We are seeking a talented individual for a Client Services Analyst 1 who is responsible for processing all incoming prior authorization and referral requests involving several state Medicaid members. This includes managing the intake process, referrals, eligibility verification, member demographic review and other related functions to the prior authorization or referral requests.

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Your role in our mission

• Ensures correct prior authorization/referral form is completed for patient’s plan. Reviews medical necessity documents for accurate information to include patient provider identification information, clinic or procedure requested, and appropriate CPT/Diagnosis codes to verify the accuracy and completeness of information submitted by healthcare providers.
• Ensures diagnoses, procedures, and services are correctly documented, in accordance with industry standards and regulatory requirements.
• Ensures diagnoses, procedures, and services are correctly documented, in accordance with industry standards and regulatory requirements.
• Validates the appropriateness of prior authorization requests and referrals based on established policies, contracts, and medical guidelines. Identifies discrepancies or inconsistencies and appropriately communicate them for further investigation.
• Monitors prior authorization requests and referrals processing activities to ensure adherence to legal and regulatory requirements, such as HIPAA, CMS guidelines, and contractual obligations.
• Updates systems with patient information and actions to ensure timely claims payment.
• Achieves daily, monthly, and quarterly quality and productivity KPIs.
• Secures patient demographics and medical information, ensuring HIPPA compliance.

What we're looking for

• Experience in processing prior authorization and referral requests, handling medical claims, and verifying member eligibility in a healthcare setting.
• Proficient in interpreting Explanation of Benefits (EOB) and UB-04 claim forms, with working knowledge of CPT, HCPCS, DRx codes, and service types.
• Familiarity with insurance payers, medical benefits, and pre-authorization procedures; understanding of Medicaid policies and medical coding (ICD-10, CPT, HCPCS) is a plus.
• Strong analytical and critical thinking skills to identify delays, resolve issues, and ensure data accuracy and reconciliation across systems.
• Excellent communication skills with a professional, customer-focused approach; ability to work effectively within a team and independently.
• Proficient in Microsoft Excel, Visio, and PowerPoint; must be available to work during prior authorization hours (7:00 AM – 6:00 PM Eastern Time).

What you should expect in this role

• Remote (work from home) All USA Locations
• Full-time (40 hours a week). May require shift work.
• May be required to work extended hours for special business needs
• Most benefits start on first day of employment
• Video cameras must be used during all interviews, as well as during the initial week of orientation.
• To work effectively as a teleworker or hybrid positions with Gainwell, employees must have a broadband internet connection with a minimum speed of 24 Mbps download and 8 Mbps upload. Higher speeds are recommended for optimal performance.
• To Test your internet download and upload speed:
  • Go to Google.
  • Search for Internet Speed Test or click here.

#LI-REMOTE #LI-JA1 #LI-CM1

The pay range for this position is $35,900.00 - $51,300.00 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 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), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.