Business Analyst - Medicaid Buy-In Operations

Gainwell Technologies is hiring a Business Analyst to support Medicare Buy-In operations. The role helps Medicare-eligible members understand coverage, eligibility, enrollment, and benefits, while researching issues and coordinating resolutions with partners.

Responsibilities:

• Answer Buy-In calls about coverage, benefits, enrollment, and eligibility
• Clearly explain Medicare Parts A and B, Medicare Savings Programs, and Medicaid Buy-In benefits
• Research and resolve coordination-of-benefits, eligibility, coverage, and enrollment issues
• Document inquiries, findings, and resolutions according to procedures
• Coordinate with members, state agencies, CMS, health plans, and internal teams
• Interpret Medicare and Medicaid policies to resolve inquiries
• Identify trends and process improvement opportunities
• Help develop requirements, procedures, and training materials
• Comply with HIPAA, CMS regulations, and Gainwell policies

Requirements:

• Bachelor's degree or equivalent experience
• At least 3 years of experience in Medicare, Medicaid, healthcare eligibility, enrollment, member services, or operations
• Experience discussing healthcare coverage with members, beneficiaries, providers, or customers
• Strong knowledge of Medicare Parts A and B, Medicare Savings Programs, and Medicaid
• Excellent communication, customer service, analytical, and problem-solving skills
• Ability to explain complex healthcare information clearly and professionally
• Proficiency in Microsoft Office and healthcare systems
• Medicare Buy-In program experience
• Knowledge of CMS regulations, Medicare eligibility, and Medicare Savings Programs (QMB, SLMB, QI, QDWI)
• Experience with state Medicaid agencies or government healthcare programs
• Call center, member services, or beneficiary support experience