Gainwell Technologies

Business Analyst

• Take charge and focus on how we can meet critical needs to help clients deliver better health and human services outcomes.
• Coordinate workstreams and teams on IT projects to align solutions with client business priorities.
• Demonstrate your knowledge as MMIS SME and liaison for clients and internally between technical and non-technical workers to transform requirements into real results.
• Delegate work across teams, and coach and monitor project team members to plan, design and improve complex business processes and modifications.
• Streamline workflows across clients and technical personnel to determine, document and oversee carrying out system requirements.
• Support quality control as you approve and validate test results to verify that all requirements have been met.
• Serve as a trusted advisor and proxy to the functional lead, ensuring alignment of priorities, risks, and execution across all provider initiatives.
• Act as the operational backbone for the Provider workstream, driving day-to-day execution while enabling leadership to focus on strategic priorities.
• Partner closely with leadership to translate strategic direction into actionable plans, timelines, and deliverables.
• Provide leadership continuity, stepping in to lead discussions, decisions, and escalations when required.

Data Engineer

• Become a healthcare insurance subject matter expert with sufficient technical skills to produce proof-of-concept solutions to various issues within the industry.
• Perform data cleaning and analysis using SQL, Python, and AI models.
• Analyze big data from diverse sources to identify trends, address gaps, and discover improvement opportunities that align with improving the healthcare system.
• Provide subject matter expertise in identifying product uses and designing strategies that address significant business and technical challenges.
• Gather and translate business requirements into analytical applications and advanced dashboard visuals, reports, or other alert systems.
• Document code using documentation tools and participate in collaborative team code reviews.
• Collaborate with various teams within the company to advise on technical solutions.
• Stay informed on industry trends, best practices, and innovations, ensuring competitive market relevance of company products.

Business Data Engineer

Project Manager

• Creates and implements complex project definitions, schedules, budgets, and objectives for a large sized or multiple projects of high complexity.
• Determines need for and impact of changes in scope of project and makes and implements recommendations based on determinations.
• Gains concurrence, approval, and consensus from stakeholders regarding the various project aspects, adjusts accordingly.
• Identifies appropriate resources and staffs projects.
• Organizes project team(s) members to ensure communication and understanding of deadlines, assignments and objectives.
• Acts as the point of contact with client project management.
• Identifies, when and as appropriate, staffing changes or needs as project progresses.
• Manages costs, schedules and quality by overseeing project deliverables.
• Ensures schedule and budget are met.
• Identifies need for change, determines course of action and revises as appropriate.
• May act outside of established policies as necessary.
• Oversees the ongoing review of project(s) status; identifies risks.
• Develops, recommends and implements risk mitigation solutions and implements as appropriate.
• Works in conjunctions with team members and stakeholders to anticipate and manage changes to projects, such as but not limited to, technical requirements, business requirements and schedule.
• Determines when additional resources are needed and implements same.
• Identifies or gathers information regarding possible solutions that may create additional, different or unique project objectives or results.
• Manages client project management, company management and project team expectations for agreed upon project performance by obtaining and providing project metrics.
• Identifies, recommends and implements changes or alternate paths based upon performance and metrics.
• Develops and makes presentations that could lead to expanded business opportunities.
• Participates in proposal efforts and sales calls to enhance opportunities for future business deals with client.
• Manages client expectations and balances the needs of company and client to ensure satisfaction for relevant parties.
• Oversees assigned personnel for projects.

Principal – Project Management

Program Manager

• Prepares work statements, scope/priority definitions, budgets and schedules for assigned moderately complex programs.
• Prepares documents with appropriate standards to meet client requirements and needs
• Assists in the staffing of projects.
• Organizes project team members to ensure communication and understanding of deadlines, assignments and objectives.
• Participates in work as applicable.
• Assists in documentation of program progress including implementation, timelines, issues, risks and successes to maintain program course.
• Conducts analyses to identify risks on the program.
• Works in conjunction with team to ensure program requirements are met as determined by established deliverables; ensures adherence to those deliverables; communicates milestones and commitments.
• Provides and assists in providing information regarding possible solutions that may create additional, different or unique project objectives or results.
• Manages client, company and project team expectations for agreed upon project performance by obtaining and providing project metrics.
• Recommends changes or alternate paths based upon performance and metrics.
• Works on the feedback provided by the client on program results; and incorporates same into future programs.
• Identifies and determines global implications of program parameters and redefines, redesigns or revises as appropriate.
• Prepares and recommends program operating and personnel budgets for approval.
• Monitors spending for adherence to budget, reviews and recommends variances as necessary.
• May provide leadership and work guidance to less experienced personnel.

Senior Professional, Program Management

Software Engineer

• Code, test, debug, implement, and document low to moderately complex programs
• Create appropriate documentation in work assignments
• Design systems and programs to meet business needs
• Prepare detailed specifications from which programs are developed and coded
• Ensure programs meet standards and technical specifications

Advisor Batch Developer – UNIX, C, SQL

Auditor

• Performs audits of medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes.
• Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates.
• Utilizes proprietary auditing systems with a high level of proficiency to document audit determinations and rationale.
• Actively cross-trains to perform reviews of multiple claim types to provide a flexible workforce to meet client needs.
• Maintains current knowledge of coding guidelines and successfully completes required CEUs to maintain coding certification.

Outpatient Coding Auditor

Communications

• Develop, review, and publish provider-facing materials, including newsletters, bulletins, alerts, policy updates, and educational resources.
• Coordinate with business partners, subject matter experts, compliance teams, and client stakeholders to ensure publication accuracy and consistency.
• Translate complex healthcare policies, operational changes, and regulatory requirements into clear and actionable communications for providers.
• Manage publication schedules, communication calendars, and approval workflows to ensure timely delivery of materials.
• Support provider outreach and education initiatives through written communications, presentations, webinars, and training materials.

Provider Publications, Communications Lead

Backend Engineer

• Code, test, debug, implement, and document moderately complex programs
• Analyze, design, and write specs and requirements from which we develop and code programs
• Evaluate existing systems and programs; assist project manager in assigning tasks and work closely with a team
• Liaise with clients and management to provide technical consulting on complex programming projects, validate program requirements, and resolve issues that arise
• Develop test plans and participate in QA activities such as coding reviews
• Participate as a member of a development team and lead a small sub-team of developers as needed
• Design system components and delegate responsibilities to team members

Senior UI Developer, .NET C#/Oracle

• Performs audits of medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes.
• Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates.
• Draws on advanced ICD-10 coding expertise to substantiate conclusions.
• Utilizes proprietary auditing systems with a high level of proficiency to document audit determinations and rationale.
• Consistently achieves productivity and quality performance standards established by management.
• Actively cross-trains to perform reviews of multiple claim types to provide a flexible workforce to meet client needs.
• Assists management with training new Coding Auditors to include daily monitoring, mentoring, feedback and education.
• Maintains current knowledge of coding guidelines and successfully completes required CEUs to maintain coding certification.
• Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.

Coding Auditor

• Translate business needs into detailed UI mock-ups and requirements/user stories that guide development efforts
• Proactively identify opportunities for system enhancements or gaps that increase product value and operational efficiency based upon new industry trends/schemes or client need
• Define acceptance criteria and expected system behavior. Apply the test scenarios to execute User Acceptance Testing to verify that systems are functioning properly and business requirements are incorporated into the system design
• Participate in post-deployment testing sessions that occur after normal business hours (Typically one Thursday evening every month)
• Communicate effectively with both technical and non-technical audiences and capable of building and maintaining relationships with key stakeholders
• Create and maintain organized product project plans through integrated management tools to support product development (i.e., Azure DevOps or other tools)
• Utilize product knowledge combined with extensive Payment/Program Integrity subject matter expertise to lead requirement elicitation meetings with clients and stakeholders
• Configure and tailor client system environments (rules, alerts, case workflows, etc.)
• Deliver product demos, walkthroughs, and training as needed
• Develop and maintain internal & client training documents, job aids, and product enhancements/release notes
• Support daily product maintenance and client satisfaction

Experienced Business Analyst – Fraud, Waste & Abuse

• Play a critical part in ensuring Gainwell is meeting our clients’ objectives in pharmacy benefit management (PBM) services
• Support Preferred Drug List (PDL) and supplemental rebate implementations and configurations
• Support PDL and supplemental rebate operations and maintenance on established accounts
• Work with a team of pharmacy clinicians and subject matter experts to configure PDL and rebate systems to deliver services to our state clients
• Apply analytical skills to evaluate and model various rebate scenarios, providing insights for decision-making
• Perform system updates related to PDL and rebate configurations to ensure accuracy and compliance
• Analyze, plan, design, document or make recommendations to improve business processes to support client’s technology goals
• Execute testing for PDL and rebate system changes to ensure functionality and reliability
• 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

Business Analyst – Preferred Drug List

Content Writer

• Analyze customer requests for proposal and information.
• Review and interpret key RFP requirements and identify issues or concerns that need resolution prior to submission of response.
• Write compelling proposal responses that accurately describe solutions, strategies, and vision while ensuring the responses embody company win themes and key differentiators.
• Collaborate with senior management, departmental experts, sales/marketing staff, and proposal leadership to implement edits and complete proposals.
• Proofread and perform quality assurance checks on all documents to ensure that proposals meet RFP requirements and accurately convey Gainwell’s strategy.
• Work with the sales organization, SMEs, and team leadership to meet deadlines in both initial submittals and follow-up as needed.
• Demonstrate an understanding of business challenges within customer markets and how company technology-enabled business solutions can address those needs.
• Develop proposal attachments, such as forms, report packages, flowcharts, implementation schedules, and sample communication materials, as required.
• Interface and coordinate with finance to verify pricing for proposal.
• Work with Production Coordinator to produce printed materials and electronic media.
• Share new or modified responses as they are developed and approved to maintain the proposal database.
• Assist other department staff as required based upon business needs.
• Other duties as assigned.

Proposal Writer

Compliance

• Oversight of all contract compliance and audit activities
• Develop and coordinate contract monitoring performance standards
• Produce monthly status reports on contract monitoring conditions
• Work with State and Gainwell Leadership on management areas
• Train and reinforce understanding of contract compliance to new staff and leadership

Contract Compliance Manager

Analyst

• Play a critical role in shaping PCMH program effectiveness measurements and incentive payment strategies to align with client program, policy, and organizational goals
• Serve as a strategic advisor to state stakeholders on PCMH program direction and tradeoffs
• Take a leading role in helping the state document, interpret, develop and enhance PCMH program policies and procedures
• Research national incentive methodologies, PCMH program operations, and the broader healthcare delivery ecosystem to recommend program improvements
• Assess the impact of incentive metric changes, policy updates, and funding options on Arkansas Fee-for-Service (FFS) providers
• Own the translation of business needs into clear data, system, and policy requirements
• Work with and guide the Data Analyst team to apply advanced analytical techniques to analyze large datasets and evaluate costs, trends, and reimbursement outcomes
• Synthesize analytic outputs to help in form program design and identify 2nd and 3rd level analyses
• Help lead Gainwell’s team in the design, development, and implementation of incentive payment methodologies for PCMH providers
• Work with the Gainwell team to ensure the accuracy, completeness, and appropriateness of metrics produced by established analytical models
• Monitor State and Federal PCMH policy changes—with an emphasis on Arkansas Medicaid—and assess their operational and financial impact
• Partner with internal teams, business leaders, and external stakeholders to promote transparency and alignment in PCMH program performance measurement practices
• Prepare high-quality written analyses, presentations, and recommendations for leadership, clients, and technical teams.

Experienced Public Policy Analyst

• Support the full product development life cycle
• Perform complex product design tasks and verify bugs
• Investigate defects and support training course development
• Work with management and cross-functional teams