Experienced Business Analyst - Provider Relations Specialist

Summary

As an Experienced Business Analyst - Provider Relations Specialist 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.

This position works under the general supervision of the Bureau of Children's Services (BCS) Internal Operations and Systems Support Section Manager, within the Division of Medicaid Services.

Here are the details on this position.

Your role in our mission

Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas.

• This position is responsible for establishing protocol and procedures for receiving and reviewing County Waiver Agency (CWA) requests to authorize rates above the Children’s Long-Term Support (CLTS) Waiver Program state service fee schedule, also known as service rate outlier requests, and work with state staff to disseminate information about the process.
• This position will monitor claims compliance in coordination with BCS policy and operation staff, claims processor - Gainwell Technology, and CWA’s.
• This position is responsible for reviewing federal guidance and research other service claims payment systems to implement, review and update the protocol and criteria as required.
• This position is responsible for managing the CLTS service fee schedule. This position is also responsible for researching and resolving discrepancies between written policy and the configuration of claims processing systems.
• This position will be responsible for provider compliance and provider integrity oversight of enrolled service providers in the CLTS program.
• This position will manage provider compliance and provider integrity through established protocol and procedures. Furthermore, the position will develop new processes and criteria, and will be responsible for receiving, analyzing and adjudicating provider integrity concerns and complaints. 
• This position will be responsible for drafting partner and provider communications such as GovD, teleconferences, webinars, bulletins, and newsletter.
• This position is responsible for managing BCS’ provider relations communication inbox and responding to partner and provider questions regarding current coverage, reimbursement, and benefit administration.
• This position is responsible for engaging and resolving concerns and questions from program partners and providers related to claims, provider compliance, and provider enrollment.
• This position will support provider enrollment system and directory projects. This includes serving as a subject matter expert for user acceptance testing in the CLTS provider registry and directory.
• This position will collaborate with policy and operational staff to establish standards for maintaining a directory of compliant providers.

What we're looking for

• Bachelor’s degree in related field or equivalent experience
• Five years of applicable experience, preferably with a human service agency
• Experience developing and implementing policy
• Experience compiling and analyzing financial data, including analysis for impact
• Experience negotiating service rates for health care, community services or non-profit programs
• Ability to interpret regulations and impact of decisions made
• Ability to facilitate effective training and related resources

Knowledge and Experience

• Knowledge of community-based waiver programs and services
• Knowledge of the federal Centers for Medicare & Medicaid Services (CMS) Home and Community-Based Services (HCBS) waiver program requirements
• Knowledge of Medicaid programs and cost allocation methodologies
• Skills and experience in providing training, technical assistance and monitoring
• Experience developing standard protocols for ongoing operations to multi-task with logical business priorities

Required Skills

• Excellent interpersonal and communication skills along with the ability to deliver constructive feedback in a diplomatic and professional manner
• Excellent written and verbal communication skills
• Strong organizational and time management skills.
• Ability to make complex independent judgments and decisions within the scope of responsibility
• Ability to interpret data to draw meaningful conclusions
• Implement strategies to address issues
• Excellent computer skills; experience with Microsoft Word, Excel and PowerPoint software

Essential Qualities

• Ability to be customer-focused and quality-driven
• Strong teamwork and collaboration skills
• Adapt to change quickly and meet deadlines on multiple projects
• Ability to develop reports for executives, program managers and others
• Must possess a valid driver’s license, maintain adequate auto insurance for job-related travel, and ability to travel within Wisconsin and other states as necessary

What you should expect in this role

• Fully remote options from Wisconsin residents only
• Video cameras must be used during all interviews, as well as during the initial week of orientation & as required from management
• This posting will remain open until a suitable candidate has been selected.

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