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SalaryIt takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
Summary
The Fraud and Abuse Review Nurse will perform provider relations activities in support of the provider services team. Perform liaison activities between staff, client staff, and provider representatives in analysis of system issues, complex billing issues, and must have strong skills with desk top tools to maximize efficiency. We are looking for an individual who is extremely intuitive in addition to analytical skills. Someone who can work independently and has good time management skills.
This nurse will be part of the FADS / SURS utilization and review team. The team has responsibility for using decision support tools to analyze claims data, practices, and patterns. Reviews of providers and recipients will be conducted, and a determination made of those that are potentially over utilizing services. If fraud may be apparent, nurses will report cases to fraud investigator. Nurses will initiate overpayment recoveries on cases involving overutilization. Must be open to use of technology as the decision support system is very powerful and a pc based application.
Your role in our mission
- Ability to interact with customers and agencies to interpret Medicaid coverage.
- Strong written/oral communication skills.
- Ability to read, understands, and interprets complex regulatory and procedural documents.
- Extensive PC skills.
- Time management and organizational skills.
- Ability to work independently without frequent supervision.
- Strong analytical skills.
- Clear telephone voice.
- Experience in public speaking.
- Ability to work with state staff to deliver training for providers and state staff.
- Ability to create training manuals and user manuals using Microsoft office products.
- Ability to analyze data and provide feedback to individual providers to improve billing practices.
- Ability to network with other organizations and individuals.
- Strong knowledge in Internet applications.
What we're looking for
- Bachelor’s degree or equivalent work experience or combination of education and experience.
- Minimum of two years Medicaid experience preferred.
- Unrestricted Registered Nurse license in the United States.
- Demonstrates strong communication skills
What you should expect in this role
- Remote (work from home) position and you must be within the continental United States of America
- Core hours for this role are 8:00 AM to 6:00 PM ET – specific hours and schedule will be determined by the supervisor and may be adjusted based on workload requirements
- Gainwell provides all needed equipment for this role (Please be sure to have a physical address on your application that you can receive items.)
- In order to effectively work as a remote worker (work from home) 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.
- To Test your internet download and upload speed:
- Go to Google.
- Search for Internet Speed Test or click here.
- Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.
- When applying please attach a resume in English.
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The pay range for this position is $61,500.00 - $87,900.00 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.
