Healthcare Analyst with Medicaid Expertise

2 weeks ago


Warwick, Rhode Island, United States HMS Full time
Take Your Expertise to the Next Level in Medicaid Claim Review

We are looking for a highly skilled Healthcare Analyst with Medicaid Expertise to join our team at Gainwell Technologies. As a key member of our healthcare solutions group, you will apply your clinical expertise to perform case reviews of Medicaid claims data, identifying potential fraud, abuse, and quality of care concerns.

The ideal candidate will possess a strong understanding of Medicaid policies and procedures, as well as excellent analytical and communication skills. This is a full-time, permanent position with a competitive salary range of $64,500 - $92,200 per year, depending on location and experience.

Key Responsibilities:

  • Utilize clinical knowledge to analyze Medicaid claim data and identify potential issues of fraud or abuse of Medicaid benefits, quality of care concerns or non-compliance with existing policy.
  • Develop and implement effective case review strategies in collaboration with cross-functional teams.
  • Present findings and recommendations to the customer using independent clinical judgment and established protocols.

Requirements:

  • Registered Nurse with at least 5 years of clinical experience.
  • Strong analytical and problem-solving skills.
  • Excellent verbal and written communication skills.
  • Familiarity with claim review and coding experience (CPT, ICD9, HCPCS) necessary.

About Gainwell Technologies:

Gainwell Technologies is a leading provider of healthcare solutions, committed to creating innovative solutions that improve healthcare outcomes for all. We offer a dynamic work environment, competitive salaries, and opportunities for career growth and development.



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