Business Analyst – Medicaid Buy-In Operations
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Job Description
Business Analyst supporting Medicare and Medicaid Buy-In operations at Gainwell Technologies. Resolving beneficiary coverage, eligibility, enrollment, and coordination issues remotely.
Responsibilities:
- Answer Buy-In calls about coverage, benefits, enrollment, and eligibility
- Explain Medicare Parts A and B, Medicare Savings Programs, and Medicaid Buy-In benefits
- Research and resolve coordination-of-benefits, eligibility, coverage, and enrollment issues
- Document inquiries, findings, and resolutions according to procedures
- Coordinate with members, state agencies, CMS, health plans, and internal teams
- Interpret Medicare and Medicaid policies to resolve inquiries
- Identify trends and process improvement opportunities
- Help develop requirements, procedures, and training materials
- Comply with HIPAA, CMS regulations, and Gainwell policies
- Support Medicare Buy-In operations and help Medicare-eligible members with coverage, eligibility, enrollment, and Buy-In questions
Requirements:
- Bachelor’s degree or equivalent experience
- At least 3 years of experience in Medicare, Medicaid, healthcare eligibility, enrollment, member services, or operations
- Experience discussing healthcare coverage with members, beneficiaries, providers, or customers
- Strong knowledge of Medicare Parts A and B, Medicare Savings Programs, and Medicaid
- Excellent communication, customer service, analytical, and problem-solving skills
- Ability to explain complex healthcare information clearly and professionally
- Proficiency in Microsoft Office and healthcare systems
- Medicare Buy-In program experience preferred
- Knowledge of CMS regulations, Medicare eligibility, and Medicare Savings Programs (QMB, SLMB, QI, QDWI) preferred
- Experience with state Medicaid agencies or government healthcare programs preferred
- Call center, member services, or beneficiary support experience preferred
- Fully remote options from most US locations and territories
- Video cameras must be used during all interviews and during the initial week of orientation
- Photo will be taken during screening for verification in all steps of the recruitment process
- Stable internet connection and quiet location required for screenings, interviews, and meetings
- Video required for screenings and interviews
Benefits:
- Work flexibility
- Learning and career development
- Flexible vacation policy
- 401(k) employer match
- Comprehensive health benefits
- Educational assistance
- Leadership and technical development academies
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