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 an EDI Gateway and Clearinghouse Product Owner 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 position.

Your role in our mission

You will be the Product Owner and the "go-to person" for that product.

Work with diverse teams to work on product changes and enhancements and deliver them on time.

Be the single owner to work with the PMO/Scrum Master to align ADO workload (from backlog) and prioritize them as required by delivery/contractual timeline.

Defines and manages the architectural roadmap for one or more platforms, products, or services.

Provides subject matter expertise in how business capabilities interact with technical capabilities to address client business problems and achieve client goals.

Provides direction for project and program design activities to ensure that both customer and company business objectives are met.

Collaborates and/or partners with business and technical architects to ensure initiatives align with business and information technology improvement strategies.

Conducts and/or participates in customer's process analysis in order to understand business complexities and constraints and recommends technical improvements.

Evaluates existing processes and recommends and implements improvements.

Enables cross-functional teams to work in parallel by providing guidance and direction in support of business solution architecture.

Supports, resolves, and documents issues that arise in the architecture.

Reviews designs and recommends improvements to the architecture.

Works with the customer to eliminate gaps and inconsistencies in the business solution architectural design and to ensure that none develop over time.

Reduces client risk by ensuring that recommended business solutions meet customer's price, scope, and time requirements.

Uses professional concepts in developing resolution to critical issues and broad design matters.

Maintains awareness of trends, best practices, and standards for the industry and related technology fields.

Introduces new technology processes as appropriate.

Provides leadership and work guidance to less experienced personnel.

Knowledge of Medicaid program regulations and compliance requirements, including HIPAA, CMS guidelines, CAQH, and state-specific Medicaid policies.

Experience with Medicaid Management Information Systems and their role in claims processing, eligibility verification, and payment systems.

In-depth understanding of electronic data interchange (EDI) principles and protocols, specifically as they relate to Medicaid programs.

Knowledge of Medicaid Enterprise System (MES) architecture and components, including interfaces with external systems and data sources.

What we're looking for

10+ years if experience with EDI software and tools, such as EDI translators, EDI gateways, and secure file transfer protocols (SFTP, FTPS, AS2)

Comprehensive understanding of the EDI process, including data formats, data mapping, data transformation, and data validation

Proficiency in Medicaid-specific EDI standards and transactions, such as X12 (including 837, 835, 834, 270/271, 275, 276/277, 278), NCPDP, or other applicable Medicaid EDI standards

Understanding of healthcare data privacy and security best practices, including encryption, access controls, audit trails, and data masking

Experience with EDI transactions commonly used in healthcare, such as claims, eligibility verification, remittance advice, and prior authorization

Familiarity with database systems, data modeling, and SQL queries, and data integration platforms commonly used in MMIS environments

What you should expect in this role

Fully Remote Opportunity

Note

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 9/2/2024.

The pay range for this position is $108,500.00 - $155,000.00 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.