Job Description

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 ​ Quality Assurance Analyst, Advisor at Gainwell, you will be a part of an innovative healthcare technology company with a mission to serve the healthcare needs of our communities. Most importantly, you’ll have the chance to grow and develop as a professional through our exceptional developmental opportunities. 

The Quality Advisor position is part of the internal quality team of all business operations and workflows in support of the Medi-Cal account. Candidate must have:

• Good analytical and problem-solving skills
• The ability to work independently with integrity
• Good interpersonal skills for interacting with project and task team members within various levels of the organization
• The ability to handle activities on multiple projects and tasks within the same or different

Your role in our mission

• Conducts assessments and evaluations through analysis and interpretation of objective and subjective evidence to establish standards and verify compliance with the organization’s quality plan. Determines level of process quality. Develops written reports of findings and escalates unresolved issues to appropriate levels.
• Evaluates policy as related to claims, appeals, and other operational processes to independently assess quality and reports findings. Research alternative solutions to problems, determines proper approaches and makes verbal and/or written recommendations and process improvements to appropriate parties.
• Gathers, uses, and independently analyzes metrics data. Presents analysis findings to the appropriate levels verbally and through the preparation of periodic written reports. Provides recommendations regarding possible approaches to resolving defects.
• Participates in special projects, external audits and process improvements in support of quality assurance initiatives.
• Reviews audit and assessment results to identify trends and issues and participates in root-cause analysis as appropriate.

What we're looking for

• Six or more years of business analyst or quality assurance experience required.
• Healthcare and/or medical insurance industry claims experience strongly preferred. Experience with Medi-cal billing processes also preferred.
• Experience/knowledge/skills with EDMS (Electronic Document Management System) / CXI - Nice / CA-MMIS
• Medicaid Provider / Enrollment experience 
• Lean Six Sigma or other related certifications and training preferred.
• Experience working with project management methodology preferred.
• Strong attention to detail as well as strong written and verbal communication skills.

What you should expect in this role

• Office environment or Work from Home (hybrid)
• Must be a resident of the state of California
• Opportunities to travel through your work (0-10%)
• Video cameras must be used during all interviews
• The deadline to submit applications for this posting has been extended until a suitable candidate has been selected.
• #LI-WM1
• #LI-Hybrid
• #LI-Quality Assurance Analyst Advisor - Operational

The pay range for this position is $84,300.00 - $120,400.00 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  , 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 and visit our 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.

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