Business Analyst – Medicaid Buy-In Operations

This is a fully remote position, open to applicants in Kansas.

📋 Description

• Respond to Buy-In inquiries regarding coverage, benefits, enrollment, and eligibility.

• Clarify details about Medicare Parts A and B, Medicare Savings Programs, and Medicaid Buy-In benefits.

• Investigate and resolve issues related to coordination-of-benefits, eligibility, coverage, and enrollment.

• Log inquiries, findings, and resolutions in accordance with established procedures.

• Collaborate with members, state agencies, CMS, health plans, and internal teams.

• Interpret Medicare and Medicaid policies to address inquiries effectively.

• Detect trends and opportunities for process enhancements.

• Assist in developing requirements, procedures, and training resources.

• Adhere to HIPAA, CMS regulations, and Gainwell policies.

• Support Medicare Buy-In operations and assist Medicare-eligible members with questions regarding coverage, eligibility, enrollment, and Buy-In.

⛳️ Requirements

• Bachelor’s degree or equivalent experience is required.

• Minimum of 3 years in Medicare, Medicaid, healthcare eligibility, enrollment, member services, or operations.

• Experience in discussing healthcare coverage with members, beneficiaries, providers, or customers.

• Strong understanding of Medicare Parts A and B, Medicare Savings Programs, and Medicaid.

• Exceptional communication, customer service, analytical, and problem-solving abilities.

• Capable of articulating complex healthcare information clearly and professionally.

• Proficient in Microsoft Office and healthcare systems.

• Experience with Medicare Buy-In programs is preferred.

• Familiarity with CMS regulations, Medicare eligibility, and Medicare Savings Programs (QMB, SLMB, QI, QDWI) is preferred.

• Background with state Medicaid agencies or government healthcare programs is preferred.

• Experience in call centers, member services, or beneficiary support is preferred.

• Fully remote options available from most US locations and territories.

• Video cameras are required during all interviews and the first week of orientation.

• A photo will be taken during screening for verification throughout the recruitment process.

• A stable internet connection and a quiet location are required for screenings, interviews, and meetings.

• Video participation is mandatory for screenings and interviews.

🏝️ Benefits

• Flexible work arrangements.

• Opportunities for learning and career advancement.

• Flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development programs.