Gainwell Technologies

Business Analyst

• Combine deep medical coding expertise with strong business analysis capability to support healthcare system operations and implementations
• Act as a bridge between operational areas, delivery teams, and client stakeholders, ensuring that coding, billing, and policy requirements are clearly defined, accurately implemented, and well documented
• Play a key role in strengthening alignment between functional areas and delivery, translating complex concepts into clear, actionable guidance that supports both system solutions and day-to-day operations for Medicaid programs
• Develop and own structured solution artifacts and operational deliverables that define coding, billing, or policy-related changes, driving them end-to-end from initial definition through review, coordination, testing alignment, implementation, and closure
• Elicit, document, and manage business, functional, and operational requirements, translating complex medical coding and billing concepts into clear, actionable deliverables
• Author and maintain claims processing instructions, policy documentation, and operational guidance in clear, plain language to support both internal teams and client stakeholders
• Analyze coding, billing, and claims-related processes and system impacts, ensuring alignment across functional areas and with technical solutions
• Serve as a bridge between operations, Business Analysts, and delivery teams, ensuring consistent understanding and application of coding and policy requirements
• Participate in and support requirements workshops, design sessions, operational discussions, and client walkthroughs
• Ensure adherence to established standards, templates, and documentation practices across all deliverables
• Maintain project coordination and communication activities, including capturing and distributing meeting outcomes, tracking status of work items, and providing updates to Project Managers, Business Leads, and stakeholders
• Provide guidance to other BAs and functional teams on coding, billing, and policy-related topics, strengthening consistency across the team

Senior Business Analyst, Medical Coding – Policy

Pharmacist

• Conduct clinical evaluations of medication therapy and review prior authorization requests using PDL criteria
• Facilitate peer-to-peer discussions with providers regarding prior authorization decisions
• Collaborate with prescribers and internal teams on clinical consultations and targeted interventions
• Support call center operations by providing clinical guidance and assisting with provider/member communications
• Serve as a subject matter expert for pharmacy-related questions across the organization
• Contribute to quality improvement initiatives and program enhancements
• Maintain clinical expertise and collaborate with cross-functional teams on pharmacy best practices
• Provide input on drug utilization reviews and formulary management
• Support Medicaid Drug Rebate Program operations and assist with state pharmacy audits
• Deliver training to pharmacy providers and contribute to reporting and administrative activities

Clinical Pharmacist Advisor

• Analyze, plan, design, document and make recommendations to improve business processes to support client’s technological aspirations
• Be a supportive bridge between clients, project managers and technical personnel to define, track and communicate business requirements and their expected impact by building basic conceptual data and process models
• Create, execute or analyze basic test scenarios to verify that client requirements are built into system design
• Ensure that 'intent of change' is carried out through every project phase by participating in technical reviews and inspections

Business Analyst – Project Management Office

Consultant

• Review Medicaid Prior Authorizations based on medical necessity in accordance with State policy guidelines
• Provide guidance and support for Medicaid Providers
• Act as a clinical SME (or liaison) for internal Gainwell entities
• Adjudicating Durable Medical Equipment and prior authorizations based on medical necessity and eligibility
• Reviewing and evaluating prior authorization submissions
• Entering prior authorization outcome into the Medicaid Management Information System (MMIS) for processing
• Participation in monthly meetings with Gainwell leadership, operational staff support, clinical peers and State stakeholders
• Providing assistance and education to the provider community related to specific prior authorization submissions
• Offering analysis and recommendations to Gainwell and State leadership on methods and potential process improvements.

Durable Medical Equipment Consultant

Business Intelligence Analyst

• Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas
• Help coordinate a business analyst team’s duties and activities on IT projects and nurture newer team members by providing guidance and support
• Be a knowledgeable bridge between clients, project managers and technical staff to define, document and share business requirements and expected impact
• Work with the client to develop business specs at the start of a technical project
• Analyze, plan, design, document or make recommendations to improve business processes to support client’s technology goals
• Help verify that all requirements have been met by approving and validating test results
• Exercise your ability to use basic analytical or relational database software — such as Excel or SQL — to quantify the anticipated impact of work

Senior Reporting Business Analyst

Software Engineer

• Participate in requirements gathering sessions to build Requirement Specification and Design Documents
• Prepare time estimates and justifications for assigned tasks
• Code, test, debug, implement and document moderately-complex to complex technical programs
• Provide on-call support, troubleshoot production issues, and perform root cause analysis
• Participate in and conduct peer reviews as needed
• Evaluate existing systems and programs to recommend potential enhancements
• Liaise with clients and management to provide technical consulting on complex programming projects

Batch Developer

SDET

• Define testing strategy, scope, and schedules for large-scale projects.
• Apply domain knowledge of Immunization Information Systems (IIS) and public health workflows to testing approaches.
• Develop and implement standard Test CoE processes, templates, and guidelines.
• Supervise and manage work allocation, demand management, and resource capacity.
• Monitor productivity and bandwidth to ensure seamless delivery across multiple projects.
• Manage project scope, issues, and changes; conduct risk assessments.
• Drive root cause analysis for defects and implement defect prevention strategies.
• Ensure day-to-day client management, service delivery scope, schedule, and quality.

Experienced Test Engineer – Immunization Registry Test Manager

• Play a critical part in ensuring Gainwell is meeting our clients’ objectives in pharmacy benefit management (PBM) services.
• Support PBM or Drug rebate implementations and configurations
• Support PBM operations and maintenance on established accounts
• Work with a team of pharmacy clinicians and subject matter experts to configure the pharmacy systems to deliver services to our state clients.
• Assist in implementation of a pharmacy payer system.
• Perform Pharmacy updates including benefit plan design, edit/audit set up, utilization controls, PDL, configuration updates, and auto prior authorization parameters
• Be a knowledgeable bridge between operations staff, clients, project managers and technical staff to define, document and share pharmacy business requirements and expected impact
• Work with the client to develop business rules and configuration requirements
• Analyze, plan, design, document or make recommendations to improve business processes to support client’s technology goals
• Help verify that all requirements have been met by approving and validating test results
• Testing point of sale (POS) pharmacy claims as required
• Exercise your ability to use basic analytical or relational database software — such as Excel or SQL — to quantify the anticipated impact of work

Senior Business Analyst – Pharmacy

General

• Process cases submitted by providers for enrollment into the program
• Review and process requests submitted by providers to update their information
• Communicate with providers through email and internal software systems, with occasional phone communication as needed
• Collaborate closely with team members to move provider requests through various stages of processing and quality assurance reviews
• Deliver exceptional customer service internally, to providers, and to clients

Provider Enrollment Agent

Project Manager

• Manage multiple projects and/or programs of varying complexity throughout the full project lifecycle
• Lead cross-functional teams to achieve project and program objectives
• Serve as project manager for smaller initiatives within assigned functions
• Collaborate with other project managers to allocate resources across projects
• Act as a team lead by assigning resources, mentoring team members, and serving as an escalation point
• Partner with Business Leads and clients to manage assigned systems, identify demand, and implement improvements