Senior Business Strategist

1 week ago


Wisconsin Rapids, Wisconsin, United States Gainwell Technologies Full time

At Gainwell Technologies, we are dedicated to unleashing the power of leading-edge technologies to improve the health and well-being of vulnerable communities. As an Experienced Business Analyst - Provider Relations Specialist, you will play a critical role in ensuring our clients' objectives are met in key areas. 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.

  • 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 researching 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.


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