35 Provider Jobs - Page 2

Gainwell Technologies LLC Gainwell Technologies is the leading provider of technology solutions that are vital to the administration and operations of health and human services programs. We are a new company (divested from DXC Technologies) with over 50+ years of proven experience, a reputation for service excellence and unparalleled industry expertise with approximately $1+ billion dollars of revenue, ~8,000+ employees who support clients across 41 U.S. states and territories with offerings including Medicaid Management Information Systems (MMIS), fiscal agent services, program integrity, care management, immunization registry and eligibility services. We offer our clients scalable and flexible solutions for their most complex challenges. These capabilities make our company a trusted partner for organizations seeking reliability, innovation and transformational outcomes. About 49M Medicaid beneficiaries are being supported. 1.3B immunization records are maintained by engaging 3.0 M providers. Our commitment to clients, drives continuous improvement in the quality of healthcare for beneficiaries nationwide through vital healthcare technology. Summary Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas. Help coordinate a business analyst team’s duties and activities on IT projects and nurture newer team members by providing guidance and support Be a knowledgeable bridge between clients, project managers and technical staff to define, document and share business requirements and expected impact Work with the client to develop business specs at the start of a technical project Analyze, plan, design, document or make recommendations to improve business processes to support client’s technology goals Help verify that all requirements have been met by approving and validating test results Exercise your ability to use basic analytical or relational database software — such as Excel or SQL — to quantify the anticipated impact of work What we're looking for Qualifications Bachelor's degree or equivalent combination of education and experience. 5 or more years of business analysis experience. Openly and actively communicates information and takes initiative to communicate extensively. 3 or more years’ experience configuring in QNXT or FACETS: Contracts/benefits. System data points needed for successful X12 transactions, Claim Adjustment Reason Codes and Remittance Advice Code. Contracts for provider services, benefits for member coverage, fee schedules, capitation, and claim editing enforcement. Understands Medicaid Program structure in carriers, programs, benefit plans, policy, policy plans, sponsor, and or policies. Understands Provider (Contract and Pricing) data including but not limited to provider type, specialty, taxonomy, enrolment impacts, service locations, certifications and licensing, affiliations, and reimbursement impacts. Understands Member data including but not limited to aid categories, coverage codes, benefit packages, restrictions, limitations, prior authorizations, programs, and primary care providers. Experience with Configuration Implementation Build & Maintenance. Experience working with complex systems at a detailed level. Experience working in a virtual team environment performing self-directed tasks. Understands relational database concepts and schemas. Experience writing SQL queries for data analysis. Experience working with Medicaid/MMIS systems. Preferred experience includes DDI (Design, Development, and Implementation) and operations phases. Experience processing Medicaid claims and ability to troubleshoot adjudication results. Demonstrated aptitude for learning new technologies and keeping current with industry best practices. Experience with Requirement Traceability Matrices. Ability to multi-task and maintain organization in a fast-paced environment. Ability to create and maintain highest levels of confidentiality when dealing with proprietary or private information. Ability to exercise sound judgment and make decisions in a manner consistent with the essential job function. Preferred experience working with HP Application Lifecycle Management (ALM). Other Qualifications Interpersonal skills to interact with customers and team members. Regular and reliable attendance is an essential function of the position. Handles difficult situations diplomatically. Good written and verbal communication skills to ensure clarity. Good analytical and problem-solving skills. Highly proficient in the use of Microsoft Office Products (PowerPoint, Excel, Word. Visio, Outlook). Presentation skills to present to management and customers. Ability to work as a team and independently. Adaptable to changing priorities. Ability to manage multiple priorities ensuring deadlines are achieved. Team and goal orientated. Ability to work in a remote environment and be self-directed with minimal supervision. What you should expect in this role Fast-paced,challenging and rewarding work environment. Work life balance. Hybrid Office environment. Will require late evening work to overlap US work hours. Configuration Analyst (US Healthcare / Medicaid) - QNxt

Gainwell Technologies LLC About Gainwell: Gainwell Technologies is the leading provider of technology solutions that are vital to the administration and operations of health and human services programs. We are the key player in the Medicaid space with a presence in 51 of the 56 U.S. states and territories with offerings including Medicaid Management Information Systems (MMIS), Fiscal Agent Services, Program Integrity, Care Management, Immunization Registry, and Eligibility Services.We generate over $2 billion in annual revenue, and we’ve been innovating in the industry for more than 50 years. Powered by more than 14,000 employees, Gainwell solutions support more than 60 million Medicaid beneficiaries nationwide and manage 1 billion encounters annually. Additionally, about 1.5 billion immunization records are maintained, and we serve more than 3 million providers annually. We do this while saving our state and commercial clients ~5.5 billion dollars annually in cost avoidance. Our commitment to clients drives continuous improvement in the quality of healthcare for beneficiaries nationwide through vital healthcare technology. In summary, there’s no company better positioned in the Medicaid and HHS (Health and Human Services) market than Gainwell. For more information on Gainwell, visit www.gainwelltechnologies.com Summary As a Business Analyst at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position. Your role in our mission Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas. Help coordinate a business analyst team’s duties and activities on IT projects and nurture newer team members by providing guidance and support Be a knowledgeable bridge between clients, project managers and technical staff to define, document and share business requirements and expected impact Work with the client to develop business specs at the start of a technical project Analyze, plan, design, document or make recommendations to improve business processes to support client’s technology goals Help verify that all requirements have been met by approving and validating test results Exercise your ability to use basic analytical or relational database software — such as Excel or SQL — to quantify the anticipated impact of work What we're looking for: As a Business Analyst at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position. 4 or more years of experience working as a business analyst or ‘requirements translator’ between technical and non-technical personnel, with 3 or more years of Medicaid and Medicare experience preferred. Work experience in Policy Strong SQL knowledge. Ability to write complex queries. Ability to gather requirements effectively; document requirements and confirm observations with business owners. Also, to perform fit/gap analysis based on requirements. Ability to create detailed and thorough design documents and test plans/execution for medium to large initiatives. Familiar with C Code History working with TMSIS Good knowledge on business analysis skills, Agile concepts, and SQL . Knowledge of computer programming concepts such as configuration, development, and batch processing Strong analytical and business process re-engineering skills Strong executive presence and communication skills to deliver messages to business leaders, clients and technical personnel. Strong communication and presentation skills. What you should expect in this role Fast-paced,challenging and rewarding work environment. Work life balance. Hybrid Office environment. Will require late evening work to overlap US work hours. Business Analyst (Medicaid) - TMSIS

Gainwell Technologies LLC Gainwell Technologies is the leading provider of technology solutions that are vital to the administration and operations of health and human services programs. We are the key player in the Medicaid space with a presence in 51 of the 56 U.S. states and territories with offerings including Medicaid Management Information Systems (MMIS), Fiscal Agent Services, Program Integrity, Care Management, Immunization Registry, and Eligibility Services. We generate over $2 billion in annual revenue, and we’ve been innovating in the industry for more than 50 years. Powered by more than 14,000 employees, Gainwell solutions support more than 60 million Medicaid beneficiaries nationwide and manage 1 billion encounters annually. Additionally, about 1.5 billion immunization records are maintained, and we serve more than 3 million providers annually. We do this while saving our state and commercial clients ~5.5 billion dollars annually in cost avoidance. Our commitment to clients drives continuous improvement in the quality of healthcare for beneficiaries nationwide through vital healthcare technology. In summary, there’s no company better positioned in the Medicaid and HHS (Health and Human Services) market than Gainwell. For more information on Gainwell, visit www.gainwelltechnologies.com Summary Essential Job Functions Assists in planning and designing business processes; assists in formulating recommendations to improve and support business activities. Assists in analyzing and documenting client's business requirements and processes; communicates these requirements to technical personnel by constructing basic conceptual data and process models, including data dictionaries and volume estimates. Assists in creating basic test scenarios to be used in testing the business applications in order to verify that client requirements are incorporated into the system design. Assists in developing and modifying systems requirements documentation to meet client needs. Participates in meetings with clients to gather and document requirements and explore potential solutions. Executes systems tests from existing test plans. Assists in analyzing test results in various phases. Participates in technical reviews and inspections to verify 'intent of change' is carried through phase of project. What we're looking for Business Analyst Summary Assists in the research and assessment of business goals, objectives and needs to align information technology solutions with business initiatives for multiple, less complex accounts. Serves as the liaison between technical personnel and business area for multiple accounts. Basic Qualifications 3+ years of experience in Business Analyst, Claims adjudication, Medicaid or Medicare, SQL. 3+ years of business functional experience in one or more areas such as Eligibility, Claims. Strong SQL knowledge. Ability to write complex queries. Ability to gather requirements effectively; document requirements and confirm observations with business owners. Also, to perform fit/gap analysis based on requirements. Experience using Microsoft Office Tools, specifically Excel. Ability to create detailed and thorough design documents and test plans/execution for medium to large initiatives. Being able to research, analyze, validate and document business requirements. What you should expect in this role Fast-paced,challenging and rewarding work environment. Work life balance. Hybrid Office environment. Will require late evening work to overlap US work hours. Req-30055 Business Analyst (Medicaid) - Claims

Gainwell Technologies LLC Summary Gainwell Technologies is the leading provider of technology solutions that are vital to the administration and operations of health and human services programs. We are the key player in the Medicaid space with a presence in 51 of the 56 U.S. states and territories with offerings including Medicaid Management Information Systems (MMIS), Fiscal Agent Services, Program Integrity, Care Management, Immunization Registry, and Eligibility Services. We generate over $2 billion in annual revenue, and we’ve been innovating in the industry for more than 50 years. Powered by more than 14,000 employees, Gainwell solutions support more than 60 million Medicaid beneficiaries nationwide and manage 1 billion encounters annually. Additionally, about 1.5 billion immunization records are maintained, and we serve more than 3 million providers annually. We do this while saving our state and commercial clients ~5.5 billion dollars annually in cost avoidance. Our commitment to clients drives continuous improvement in the quality of healthcare for beneficiaries nationwide through vital healthcare technology. In summary, there’s no company better positioned in the Medicaid and HHS (Health and Human Services) market than Gainwell. For more information on Gainwell, visit www.gainwelltechnologies.com Your role in our mission Essential Job Functions Assists in planning and designing business processes; assists in formulating recommendations to improve and support business activities. Assists in analyzing and documenting client's business requirements and processes; communicates these requirements to technical personnel by constructing basic conceptual data and process models, including data dictionaries and volume estimates. Assists in creating basic test scenarios to be used in testing the business applications in order to verify that client requirements are incorporated into the system design. Assists in developing and modifying systems requirements documentation to meet client needs. Participates in meetings with clients to gather and document requirements and explore potential solutions. Executes systems tests from existing test plans. Assists in analyzing test results in various phases. Participates in technical reviews and inspections to verify 'intent of change' is carried through phase of project. What we're looking for Basic Qualifications 3+ years of experience in Business Analyst, Provider, Claims adjudication, Medicaid or Medicare, SQL. 3+ years of business functional experience in one or more areas such as Eligibility, Claims, Provider. Strong SQL knowledge. Ability to write complex queries. Ability to gather requirements effectively; document requirements and confirm observations with business owners. Also, to perform fit/gap analysis based on requirements. Experience using Microsoft Office Tools, specifically Excel. Ability to create detailed and thorough design documents and test plans/execution for medium to large initiatives. Being able to research, analyze, validate and document business requirements. What you should expect in this role Fast-paced,challenging and rewarding work environment. Work life balance. Hybrid Office environment. Will require late evening work to overlap US work hours. Business Analyst Professional (US Healthcare / Medicaid) - Provider

Gainwell Technologies LLC Summary As a Business Analyst at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position. Your role in our mission Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas. Help coordinate a business analyst team’s duties and activities on IT projects and nurture newer team members by providing guidance and support Be a knowledgeable bridge between clients, project managers and technical staff to define, document and share business requirements and expected impact Work with the client to develop business specs at the start of a technical project Analyze, plan, design, document or make recommendations to improve business processes to support client’s technology goals Help verify that all requirements have been met by approving and validating test results Exercise your ability to use basic analytical or relational database software — such as Excel or SQL — to quantify the anticipated impact of work What we're looking for Business Analyst Summary Assists in the research and assessment of business goals, objectives and needs to align information technology solutions with business initiatives for multiple, less complex accounts. Serves as the liaison between technical personnel and business area for multiple accounts. Basic Qualifications 8+ years of experience in Business Analyst, Provider, Claims adjudication, Medicaid or Medicare, SQL. 8+ years of business functional experience in one or more areas such as Eligibility, Claims, Provider. Strong SQL knowledge. Ability to write complex queries. Ability to gather requirements effectively; document requirements and confirm observations with business owners. Also, to perform fit/gap analysis based on requirements. Experience using Microsoft Office Tools, specifically Excel. Ability to create detailed and thorough design documents and test plans/execution for medium to large initiatives. Being able to research, analyze, validate and document business requirements. What you should expect in this role Fast-paced,challenging and rewarding work environment. Work life balance. Hybrid Office environment. Will require late evening work to overlap US work hours. Req-29890 Business Analyst (US Healthcare / Medicaid) - Provider

WE HAVE AN URGENT REQUIREMENT OF AR CALLERS & AR FOLLOW UP CANDIDATES #AR follow-up with insurance companies & patients. #To follow up on claims assigned. #To Complete EDI rejections #End to End RCM Knowledge #Good knowledge of modifiers & softwares Required Candidate profile #EXPERIENCE : 01 TO 06 YEARS IN AR CALLING & FOLLOW UP US HEALTHCARE RCM #NIGHT SHIFTS #SALARY : 2.50 LPA TO 6.00 LPA + INCENTIVES #CALL/WATSAPP : PRAYAG : 9911985567 #vrtalenthunters6210@gmail.com Perks and benefits #best Salary & Incentives Plans Virtual Interviews

Role: Credentialing Specialist, US Healthcare Location: Pune/Mumbai/Nagpur (Work from Office) (Address details mentioned below) Company Profile: First Insight is a software product development and revenue cycle management company based in Portland, Oregon (USA). It has its India development and service delivery centres in Pune, Mumbai and Nagpur. Its expertise and domain lies in healthcare and insurance. Its a forward thinking, visionary company that provides high quality software solutions, services, support and training to nearly a thousand optometric and ophthalmic practices in the United States. It has carved a niche in the healthcare industry with its practice management and electronic health records software, support, e- commerce solutions and revenue cycle management services. To know more about First Insight, please visit @ www.first-insight.com Following would be the Duties/Responsibilities for Credentialing Specialist: Maintain individual provider files to include up to date information needed to complete the required federal and commercial payer credentialing applications. Maintain an internal provider grid to ensure all information is accurate and logins are available. Update each provider's CAQH database file timely according to the schedule published by CMS. Tracks expiration dates and maintains current state licenses, DEA certification, malpractice coverage and any other required documents for all providers. Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance Track all expired provider certification. initiate re-credentialing application as requested by insurance companies. Follow up with providers for missing information or documents. Complete revalidation requests issued by federal payers. Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid Complete re-credentialing applications for commercial payers. Work closely with the billing staff to identify and resolve any denials or authorization issues related to provider credentialing. Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases. Streamline the credentialing process by efficiently collecting all necessary documentation, including accreditation, membership, and facility privileges (e.g., License, NPI letter). Guide and support providers in completing payer forms, ensuring strict compliance with payer expectations. Address provider inquiries regarding the progress of the credentialing process promptly and professionally. Proactively notify clients of new regulations, impending certificate expirations, reapplications, and any deficiencies in credentialing requirements. Qualifying Criteria: At least 1+ year of experience in Credentialing process in US Healthcare (End to End RCM Process) Ability to multi-task Good organization skills demonstrating the ability to execute timely follow-ups Willingness to be a team player and show initiative where needed Ready to work in night shifts Excellent oral and written communication skills Salary: Remuneration will be at par with the best industry standards ; will not be a constraint for the right candidate. Perks & Benefits : Attractive Incentives Plan Travelling Allowance Mediclaim Monthly Rewards Interested Candidate can also share their resumes directly to the recruiters below: Rohit Ghate - 7888025217 rohitghate@first-insight.com Address details: Registered Office Address- Pune: First Insight Software Solutions (I) Pvt. Ltd., 2nd Floor, Server Space, AG Technology Park, Off ITI Road, S. No.127/1A, Plot No.8, Aundh, Pune 411 007 Mumbai: Unit No. 302, 3rd Floor, New Technocity, Plot No. X-4/5A, TTC Industrial Area, Mahape MIDC, Navi Mumbai - 400 710 Nagpur: Unit No. 201, 2nd Floor, Wing - C, VIPL IT Park, Plot No. 28, MIDC IT Park, Gayatri Nagar Road, Parsodi, Nagpur - 440 022

We are hiring for Leading ITES Company for AR Caller - Healthcare Profile Location: Hyderabad Salary: Upto 32k in hand Role & responsibilities: Responsibilities: Minimum 1 year experience in AR Calling in medical billing field Should handle US Healthcare providers/ Physicians/ Hospital's Accounts Receivable. To work closely with the team leader. Good Knowledge of RCM and Denial management. Ensure that the deliverables to the client adhere to the quality standards. Responsible for working on Denials, Rejections, LOA's to accounts, making required corrections to claims. Calling the insurance carrier & Document the actions taken in claims billing summary notes. To review emails for any updates Identify issues and escalate the same to the immediate supervisor Maintain AR medical billing claims/accounts at an acceptable level. Work in teams that process medical billing transactions and strive to achieve team goal In some cases To make calls to insurance companies or to the client to follow up on unpaid claims. Absorb all business rules provided by the customer and process transactions with a high standard of accuracy and within the stipulated turnaround time Follow up on the claims for collection of payments. To Apply WhatsApp 'Hi' @ 9151555419 and Follow the Steps Below: a) For Position in Hyderabad Search : Hospital Billing (Job Code # 117) b) For Position in Hyderabad Search : Physician Billing (Job Code # 118)

Flutter and Dart Programming for Mobile App Development. Perks and benefits Medical Insurance.

We Are Hiring || AR Callers || Locations :- Hyderabad, Chennai & Mumbai || PHYSICIAN BILLING : Experience :- Min 1 year of experience into AR Calling - Physician Billing Package :- Up to 40K Take home Locations :- Hyderabad , Mumbai , Chennai, Noida & Gurugram Qualification :- Inter & Above Notice Period :- 0 - 20 days WFO HOSPITAL BILLING : Experience :- Min 1 year of experience into AR Calling - Hospital Billing Package :- Up to 40K Take home Locations :- Hyderabad , Mumbai , Chennai Qualification :- Inter & Above Reliving not mandatory Notice Period :- Preferred Immediate Joiners WFO CREDIT BALANCE : Experience :- Min 1 year of experience into Credit Balance Package :- Up to 40K Take home Locations :- Hyderabad Qualification :- Inter & Above Reliving not mandatory Notice Period :- Preferred Immediate Joiners WFO Perks and benefits Incentives Allowances 2 way Cab Interested candidates can share your updated resume to HR Harshitha - 7207444236 (share resume via WhatsApp) harshithaaxis5@gmail.com Refer your friend's / Colleagues