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 Gainwell 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 a EDI Gateway & Integration Solutions Lead/Manager 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 postion.
Your role in our mission
• Manages applications business development and account management teams in building and maintaining strong, positive business partner relationships with clients or potential clients.
• Manages end to end service delivery ensuring that account specific objectives for applications services are met on large accounts; develops account operational plans; reviews and resolves issues and problems related to staffing and estimating, client concerns, and center operations.
• Creates alternative approaches, focusing on strategic or long-term approaches, for client needs as warranted.
• Ensures fiscal control by developing, monitoring and adjusting budgets and forecasts for large accounts or groups of accounts to achieve account financial targets including revenue, cost, margin and operating income objectives.
• Recommends and implements changes or adjustments as appropriate.
• Ensures client relationships and satisfaction are maintained by meeting current and potential applications needs, ensuring contract compliance, developing long term application strategies and monitoring and resolving client satisfaction survey results.
• Creates and implements alternative strategies as needed.
• Collaborates with account teams on applications business development growth strategies within the existing accounts; formulates and executes designed business development plans to meet growth targets that will increase revenue and market share while continuing to grow and expand the account(s), leverages use of innovation, works with account management teams and service delivery resources to identify and develop solution opportunities and ensure appropriate implementation of customer solutions.
• Understands and articulates value propositions; understands and leverages operating models to ensure that appropriate, dedicated shared, on-site, off-site, offshore contractor, and company resources are available to meet client needs.
• Maintains expertise in management of client relationships and applications outsourcing, understanding of applications development methodology, best practices and principles, while sharing and collaborating with other team members.
• Selects and hires employees.
• Trains and evaluates employees to enhance their performance, development, and work product.
• Addresses performance issues and makes recommendations for personnel actions.
• Motivates and rewards employees including providing salary increases, bonuses and promotions within allocated budgets and company guidelines.
• Prepares, recommends and oversees development of operating and personnel budgets.
• Monitors spending for adherence to budget plans, develops and recommends variances.
• Performs and/or oversees budget analysis.
What we're looking for
Extensive Experience and Leadership:
- Over twelve years of experience in applications development, with a strong track record of delivering complex technical solutions.
- Eight years of leadership and supervisory experience, successfully managing teams and guiding projects to successful completion.
EDI and Healthcare Standards:
- Expertise in X12 standards, particularly X12 835, for healthcare claim payment advice.
- Proficient in CAQH CORE (Committee on Operating Rules for Information Exchange), ensuring efficient and compliant healthcare data exchange.
- Strong understanding of how EDI (Electronic Data Interchange) integrates with multiple endpoints across workflows, EDMS (Electronic Document Management Systems), and portal technologies.
Platforms & Technologies:
- Advanced proficiency in SQL for database query, management, and optimization.
- Extensive experience with QNXT (healthcare management software), focusing on claims management and processing.
- Expertise in Edifecs X-Engine for EDI data transformation and mapping to ensure seamless data exchange.
- In-depth knowledge of Gateway systems, enabling secure and efficient data transmission across platforms.
Industry Knowledge:
- In-depth understanding of US Medicaid and PBM (Pharmacy Benefit Management), including claims processing, Rx claims, and Medicaid regulations.
- Ability to adapt industry knowledge to complex technical workflows to ensure compliance and effective system performance.
Problem-Solving and Analytical Skills:
- Strong troubleshooting and analytical skills, with a proven ability to resolve complex issues in technical workflows.
- Quick to learn and adapt to new technologies, processes, and regulatory changes, ensuring continuous improvement and innovative solutions.
What you should expect in this role
This is a fully remote position with the flexibility to work from home, and we are considering candidates from all US locations.
Video cameras must be used during all interviews, as well as during the initial week of orientation.
The deadline to submit applications for this posting is Friday May 3, 2024.
This posting is intended for pipelining. We will accept applications on an ongoing basis.
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The pay range for this position is $101,200.00 - 162,700.00 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.
