Reference Analyst- Hybrid Williston, VT

Summary

Gainwell Technologies provides technology solutions that help healthcare clients improve the well-being of the members they serve. The Reference Analyst will support the Department of Vermont Health Access with coding, pricing, claims processing reviews, reference file maintenance, audits, system updates, compliance analysis, and documentation.

Responsibilities

• Liaison with the Department of Vermont Health Access (DVHA) to support coding, pricing, and claims processing reviews
• Update and maintain reference file screens and claims processing system attributes to ensure compliance with Correct Coding requirements
• Set up and maintain relationship and limitation audits as directed by DVHA
• Partner with the Systems team to implement, test, and verify high-volume reference file updates and system changes
• Review claims processing data for compliance, recommend necessary changes, update resolution instructions, and maintain documentation of all system updates

Skills

• Strong oral and written communication skills with the ability to work effectively independently and as part of a team
• Knowledge of Vermont Medicaid policies and proficiency in Professional and Institutional claims billing processes
• Strong attention to detail with the ability to analyze information, prioritize tasks, and make informed decisions
• Ability to manage multiple priorities and competing deadlines while meeting SLA and departmental requirements
• Proficiency in Microsoft Word, Microsoft Excel, and other PC-based systems
• CPC certification preferred

Qualifications

Must Haves

• Strong oral and written communication skills with the ability to work effectively independently and as part of a team
• Knowledge of Vermont Medicaid policies and proficiency in Professional and Institutional claims billing processes
• Strong attention to detail with the ability to analyze information, prioritize tasks, and make informed decisions
• Ability to manage multiple priorities and competing deadlines while meeting SLA and departmental requirements
• Proficiency in Microsoft Word, Microsoft Excel, and other PC-based systems

Nice to Haves

• CPC certification preferred

Benefits

• All salaried, full-time candidates are eligible for our generous, flexible vacation policy
• 401(k) employer match
• Comprehensive health benefits
• Educational assistance
• A variety of leadership and technical development academies to help build your skills and capabilities
• Hybrid Williston, VT