Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.
Summary
Gainwell is looking for a Pharmacy Claims Finance Lead to join the Texas Vendor Pharmacy Modernization (VPM) Team. As a member of the Team you will be directly involved in the day-to-day pharmacy claims adjudication financial activities, provider recoupments and non-risk payments, and quality assurance activities
Your role in our mission
- Perform day-to-day financial activities associated with pharmacy claims adjudication, ensuring accuracy and timely processing of payments.
- Oversee pharmacy provider recoupment processes, manage, and coordinate non-risk payment process involving managed care, and conduct quality assurance activities involving the pharmacy claims payment cycle, identifying and resolving any discrepancies.
- Act as the primary point-of-contact for pharmacy claim payment financial topics for the client and stakeholders, contributing to effective communication and outreach strategies.
- Updates pharmacy claim payment procedures and associated materials, including policies and procedures, desk-level procedures, and manuals.
- Coordinate or manage the activities of other financial staff.
What we’re looking for
- Five or more years of finance, accounting, or equivalent experience
- Healthcare claims adjudication and processing experience
- Experience working with Medicaid/MMIS, pharmacy benefit manager, or related healthcare entity preferred.
- Experience with claims processing and/or financial reporting in a healthcare environment preferred.
- Experience using financial software such as Flexi preferred.
What you should expect in this role
- Video cameras must be used during all interviews, as well as during the initial week of orientation.
- Remote position with hybrid option, if selected candidate resides in Austin, TX area.
- Limited travel (<10%) required to our office in Austin, Texas to support client engagement and project priorities.
- To effectively work as a teleworker with Gainwell, employees Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload. Greater speeds will of course provide better performance.
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The pay range for this position is $51,700.00 – $73,800.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.