Early Career Business Analyst - Operations

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at HMS, a Gainwell Company carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary

As an

Early Career Business Analyst - Operations

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.

We are seeking a highly motivated and detail-oriented

Operations Business Analyst

to join our team. This position is responsible for the daily posting and accounts receivable (AR) reconciliation of medical payments to claims, based on both paper and electronic Explanation of Benefits (EOBs) from insurance carriers. The analyst will correct errors, modify posting issues, and generate monthly invoices based on claims processed during the reporting period. This role requires strong problem-solving skills , the ability to work independently in a remote environment , and experience in healthcare claims . The ideal candidate will be comfortable navigating complex systems and processes and have a deep understanding of medical and pharmacy claims adjudication , Medicaid reclamation , and healthcare payment cycles.

• Post payments to medical and pharmacy claims from paper and electronic EOBs daily.
• Reconcile AR and correct any discrepancies or posting issues.
• Identify, analyze, and resolve errors in claim postings and payments.
• Participate in meetings with client engagement to gather and document requirements and explore potential solutions.
• Assist in analyzing and documenting client's business requirements and processes following established approach and methodology; communicates these requirements to technical personnel.
• Plans and designs standard business processes following established approach and methodology; assists in formulating recommendations to improve and support business activities.
• Develops and modifies systems requirements documentation to meet client needs.
• Generate and distribute monthly invoices using PeopleSoft Finance based on claims posted during the reporting period.
• Create, run, and deliver posting and reconciliation reports ; analyze trends and anomalies.
• Use FTP protocols to securely transfer files from various sources.
• Maintain accurate documentation for audit and compliance purposes.
• Collaborate with other departments to resolve issues related to claims and payments.
• Work independently in a remote environment while meeting deadlines and service level agreements (SLAs).

What we’re looking for

• Bachelor’s degree in Business, Healthcare Administration, Finance, or a related field; OR 3–5 years of experience in medical claims posting and reconciliation .
• Solid understanding of medical and pharmacy claims adjudication , and Medicaid reclamation claims .
• Proficiency in SQL and ability to extract and analyze data from relational databases.
• Familiarity with PeopleSoft Finance or similar enterprise financial systems.
• Strong critical thinking and problem-solving skills ; able to troubleshoot independently.
• Experience with FTP protocols and secure file transfer.
• Excellent written and verbal communication skills .

Preferred Qualifications

• Experience working with healthcare data analytics or reporting tools.
• Prior experience in a remote or hybrid work environment .
• Knowledge of healthcare payment cycles and insurance reimbursement processes

What you should expect in this role

• Fully remote options from Contiguous US locations only

The pay range for this position is $44,500.00 - $63,500.00 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 HMS, a Gainwell Company. 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 HMS, a Gainwell Company, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth.

Learn more about HMS, A Gainwell Technologies Company at our company website and visit our Careers site for all available job role openings.

HMS, a Gainwell Company, is 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), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

HMS defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.