Senior Business Analyst

Gainwell, through HMS, provides technology solutions designed to improve healthcare outcomes for vulnerable communities. The Senior Business Analyst posts and reconciles medical and pharmacy claims payments, resolves claim and payment discrepancies, and supports client requirements gathering, business process analysis, and communication with technical personnel.

Responsibilities:

• 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
• Participates in meetings with client engagement to gather and document requirements and explore potential solutions
• Assists in analyzing and documenting client's business requirements and processes following established approach and methodology; communicates these requirements to technical personnel
• Reconcile AR and correct any discrepancies or posting issues
• Identify, analyze, and resolve errors in claim postings and payments
• Participates in meetings with client engagement to gather and document requirements and explore potential solutions
• Assists in analyzing and documenting client's business requirements and processes following established approach and methodology; communicates these requirements to technical personnel

Requirements:

• 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
• Strong attention to detail and organizational skills