Healthcare Consultant

2 weeks ago

Tucker, Georgia, United States Gainwell Technologies Full time
About the Role

We are seeking a highly skilled Healthcare Consultant to join our team at Gainwell Technologies. As a key member of our organization, you will play a critical role in helping our clients improve the health and well-being of their members.

Key Responsibilities
  • Assist providers with investigation of problematic claims at the point of escalation or intervention with Field Representative.
  • Monitor and keep abreast of billing manual changes as it relates to claims processing, etc. and their impact on the provider community.
  • Interact with DCH employees to resolve complex issues/topics that cannot be resolved in-house.
  • Monitor and utilize GAMMIS and related documentation to resolve claims processing issues.
  • On-site training seminars and workshops, as required.
  • Assist with special projects as assigned by Supervisor or Manager (i.e., Call Center support or Provider Outreach).
  • Resolve and follow-up on all open CTNs within 72 business hours of CTMS assignment.
  • Review and resolve special processing of claims (Special Batching).
  • Complete a weekly status report.
  • Assist in the organization, implementation, and execution of 2 Medicaid fairs tentatively scheduled for April and October.
  • Accompany a Field Rep on at least four (4) on provider visits per calendar month (combination of on-site and virtual if in-person visits are not available).
  • Using the Consultant Buddy System, coach, and mentor to develop Field Reps and In-House Representatives by communicating weekly to ensure they are on the right track.
  • Implement and communicate to Manager ways to create a seamless process between departments within our organization monthly.
Requirements
  • Bachelor's degree in Business Administration or Health Services Administration (strongly preferred).
  • Minimum of 1 year of experience in healthcare billing.
  • 5 years of experience in healthcare public relations, or an equivalent combination of education and experience.
  • Preferred: At least 2 years of experience with Medicaid claims, policies, and procedures.
  • Required on-site visits to the Tucker, GA office.
What We Offer

We offer a competitive salary range of $56,000 to $80,400 per year, depending on location, experience, and qualifications. Additionally, we provide a comprehensive benefits package, including health insurance, 401(k) matching, and educational assistance. Our company values work flexibility, learning, and career development, and we offer a variety of leadership and technical development academies to help you grow your skills and capabilities.

We are an equal opportunity employer and welcome applications from diverse candidates. If you are passionate about making healthcare work better for everyone, we encourage you to apply for this exciting opportunity to join our team at Gainwell Technologies.

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