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Gainwell Technologies logo
Gainwell Technologies

Gainwell Technologies is an award-winning digital health technology company that supports the administration of healthcare and human services programs. In past flexible hiring, the

Client Services Analyst I

Location

Texas

Posted

102 days ago

Salary

$35.9K - $51.3K / year

Seniority

Senior

High School3 yrs expEnglishSQLTableau

Job Description

Client Services Analyst I

Gainwell Technologies

• Processing all incoming prior authorization and referral requests involving several state Medicaid members • Managing the intake process, referrals, eligibility verification, member demographic review and other related functions to the prior authorization or referral requests • Ensures correct prior authorization/referral form is completed for patient’s plan • Reviews medical necessity documents for accurate information to include patient provider identification information, clinic or procedure requested, and appropriate CPT/Diagnosis codes to verify the accuracy and completeness of information submitted by healthcare providers • Ensures diagnoses, procedures, and services are correctly documented, in accordance with industry standards and regulatory requirements • Validates the appropriateness of prior authorization requests and referrals based on established policies, contracts, and medical guidelines • Identifies discrepancies or inconsistencies and appropriately communicate them for further investigation • Monitors prior authorization requests and referrals processing activities to ensure adherence to legal and regulatory requirements, such as HIPAA, CMS guidelines, and contractual obligations • Updates systems with patient information and actions to ensure timely claims payment • Achieves daily, monthly, and quarterly quality and productivity KPIs • Secures patient demographics and medical information, ensuring HIPPA compliance

Job Requirements

  • High School Diploma or GED required
  • Minimum of 3 years of client service experience
  • Healthcare industry experience preferred
  • Exposure to SQL Server, reporting tools, or business intelligence platforms (e.g., Tableau) preferred
  • Strong analytical skills with the ability to apply logic and structured processes to resolve work-related issues and identify improvement opportunities
  • Ability to develop and translate client-specific processes between technical and non-technical stakeholders
  • Demonstrated attention to data accuracy and quality, including experience reconciling data across multiple systems or platforms

Benefits

  • Most benefits start on first day of employment
  • Generous, flexible vacation policy
  • 401(k) employer match
  • Comprehensive health benefits
  • Educational assistance
  • Leadership and technical development academies

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