Gainwell Technologies

Trainer

• Deliver engaging and interactive training sessions to new and existing call center agents
• Deliver general training for departments such as Claims and Provider Enrollment
• Facilitate virtual training programs to enhance employee skills and performance
• Adapt training delivery to various learning styles and needs
• Design visually engaging and interactive training materials and presentations using modern adult learning principles
• Collaborate with the LKI training team, subject matter experts, and account leaders to ensure training materials are effective and user-friendly
• Provide post-training support and resources to learners and call center leadership
• Assess training outcomes through surveys, feedback, and performance metrics
• Create and deliver learning initiatives supporting Gainwell’s Medicaid members and providers

Professional Trainer

AI Engineer

• Design, build, and train machine learning and deep learning models, including GenAI, NLP, and predictive analytics solutions for healthcare applications
• Develop, test, and deploy AI solutions in cloud and on-premise environments
• Work with large healthcare datasets, including data preprocessing, feature engineering, and model training
• Ensure compliance with HIPAA and other regulatory standards
• Implement and optimize AI models within Gainwell’s existing technology stack
• Collaborate with software engineers to ensure seamless system integration
• Monitor, refine, and optimize AI models for accuracy, efficiency, and speed using MLOps best practices
• Stay current with AI/ML advancements and explore new technologies and methodologies
• Ensure AI implementations adhere to healthcare regulations, ethical AI principles, and data privacy standards
• Identify opportunities to automate workflows and optimize business processes using AI-driven solutions

Principal AI Engineer

Human Resources

• Serve as a first point of contact for managers and employees on HR policies, procedures, programs, and general HR guidance
• Support employee relations matters, including employee concerns, issue resolution, performance documentation, and engagement initiatives
• Escalate complex employee relations issues as appropriate
• Provide guidance to managers on foundational performance management practices, including goal setting, feedback conversations, and development planning
• Support talent-related processes such as recruiting coordination, onboarding, internal transfers, and workforce planning activities
• Ensure consistent application of HR policies and procedures while maintaining compliance with federal, state, and local employment regulations
• Prepare and maintain HR documentation, records, and case notes in accordance with company and confidentiality standards
• Compile and analyze HR reports, dashboards, and metrics to support decision-making and identify workforce trends
• Partner with HR Centers of Excellence to support deployment of HR programs and initiatives
• Participate in process improvement initiatives and contribute ideas to enhance efficiency and employee experience
• Maintain current knowledge of HR best practices, employment law updates, and organizational policies
• Perform other duties and responsibilities as assigned

Senior HRBP

Auditor

• Perform itemized bill review, chart review, and coding validation
• Verify billed services and procedures were performed, covered, ordered, documented, and reimbursed according to policies and provider contracts
• Evaluate coding, charging, and reimbursement for inpatient hospital and outpatient facility services
• Use proprietary auditing systems to document audit findings and rationale
• Review appeals and redeterminations using approved clinical and coding guidelines
• Analyze appeal documentation and document appeal determinations
• Prepare case files and case summaries for hearings
• Participate in virtual and on-site hearings
• Achieve productivity and quality standards
• Cross-train to review multiple claim types
• Assist management with training, monitoring, mentoring, feedback, and education for new Coding Auditors
• Maintain current coding guideline knowledge and complete required CEUs
• Attend training and scheduled meetings

Lead Coding Auditor, Itemized Bill Review and Appeals

Analyst

• Review Medicaid drug rebate payments, invoices, and outstanding balances to identify discrepancies and support timely resolution
• Research disputed pharmaceutical utilization and claims data
• Develop accurate rebate dispute resolution recommendations
• Communicate and negotiate with drug manufacturers to resolve rebate disputes
• Follow up on unpaid or outstanding invoices
• Work with pharmacies, medical providers, and internal partners to verify claims information
• Obtain documentation needed to research and resolve discrepancies
• Track and prioritize dispute-resolution activities
• Manage assigned workflow queues and maintain accurate records
• Complete required productivity reporting
• Regularly interact with drug manufacturers, pharmacies, medical providers, customers, and internal business partners
• Occasionally report to the Charleston, WV office based on business needs

Drug Rebate Analyst

Call Center Representative

• Provide day-to-day guidance, coaching, and support to Customer Service Representatives serving California's Medi-Cal members and providers
• Monitor team performance and identify coaching opportunities
• Reinforce quality, productivity, attendance, and customer service expectations
• Assist with resolving member and provider escalations
• Support compliance with company policies and client requirements
• Partner with supervisors, Quality, Training, and Workforce Management to support operational goals and continuous improvement initiatives
• Serve as a subject matter expert by answering questions
• Assist with new hire onboarding
• Reinforce process and policy updates

Call Center Agent – Provider Lead EDI

• Conduct detailed reviews of medical records, claims, and supporting documentation to determine the accuracy and appropriateness of assigned ICD-10-CM, CPT, HCPCS Level II, and modifiers
• Apply contract-specific review methodologies to identify coding discrepancies, billing errors, reimbursement inaccuracies, and compliance concerns
• Evaluate documentation to ensure coding assignments are supported and compliant with applicable regulatory and payer requirements
• Accurately document audit findings, rationale, and recommendations using proprietary audit and case management systems
• Provide comprehensive coding and reimbursement determinations supported by clinical documentation, coding guidelines, payment methodologies, and regulatory requirements
• Perform ongoing quality assurance audits of coding and clinical review staff
• Interpret and apply official coding guidelines, CMS regulations, NCCI edits, OPPS requirements, EAPG methodologies, APC payment policies, and ASC reimbursement guidelines
• Assess auditor and reviewer performance against quality benchmarks and productivity standards
• Identify process improvement opportunities and recommend corrective actions
• Participate in inter-rater reliability activities and quality calibration sessions
• Assist in developing quality monitoring processes, audit tools, and review protocols
• Serve as a subject matter expert on outpatient coding, reimbursement methodologies, and payment integrity principles
• Achieve productivity and quality performance standards established by management

Lead Associate, Outpatient Coding Quality Auditor

Manager

• Lead the design, delivery, and ongoing support of client engagements on enterprise integration and interface solutions
• Oversee development of REST APIs, FHIR integrations, batch interfaces, EDI transactions, file-based exchanges, and real-time integrations
• Manage the end-to-end integration lifecycle from requirements through deployment and production support
• Lead source-to-target mapping, data conversion, reconciliation, and migration activities
• Establish integration standards, governance, best practices, and reusable frameworks across programs
• Improve client services delivery through AI-based data compression techniques and automations
• Coordinate with business, technology, implementation, and client stakeholders
• Oversee project planning, resource management, risk mitigation, and delivery execution for interface workstreams
• Champion automation, operational efficiency, and continuous improvement initiatives
• Build and mentor high-performing integration teams
• Ensure compliance with HIPAA, CMS, state, and client-specific regulatory requirements

Senior Manager, Application Development

QA Engineer

• Monitor and evaluate customer interactions in English and Spanish
• Ensure adherence to established quality standards, client requirements, policies, procedures, and performance expectations
• Complete quality evaluations accurately and consistently
• Document findings and identify opportunities to improve quality, accuracy, compliance, and customer experience
• Analyze quality results and customer interaction trends
• Identify recurring issues, performance gaps, and improvement opportunities
• Participate in calibration sessions to promote consistency in quality evaluations, scoring, and interpretation of quality standards
• Prepare quality reports and communicate trends, findings, and recommendations to Quality and Operations leadership
• Partner with Quality, Operations, and Training teams to support coaching, process improvements, and continuous improvement initiatives
• Support California's Medi-Cal program and contact center operations serving members and providers

Bilingual Call Center Quality Assurance Analyst

Backend Engineer

• Assist in developing, implementing, and managing technology-based business solutions
• Code, test, and implement configuration changes
• Assist in designing software applications meeting functional and technical requirements
• Gather requirements directly with clients
• Work with the Gainwell account team to build business designs
• Create and execute test cases and system documentation
• Manage and coordinate work across functional areas with project managers and team leaders
• Design, develop, document, test, and debug new and existing large-scale software systems and applications
• Participate in the full development life cycle, including requirements analysis, design, and testing
• Rapidly prototype and present conceptual designs and working prototypes to management
• Keep up to date on best practices and new technologies

.Net Developer

Data Scientist

• Design, build, and train machine learning, deep learning, time series, Gen AI, predictive analytics, natural language processing, and image processing solutions for healthcare applications.
• Develop, test, and deploy AI solutions in cloud and on-premises environments.
• Perform data preprocessing, feature engineering, and model training while ensuring compliance with HIPAA and other regulatory standards.
• Develop APIs and integrations.
• Implement and optimize AI models within Gainwell’s existing technology stack, collaborating with software engineers.
• Evaluate models and continuously monitor the performance of ML/DL and LLM systems.
• Apply security measures and guardrails in Gen AI solutions.
• Monitor, refine, and optimize AI/Gen AI models for accuracy, efficiency, and speed using MLOps and LLMOps practices.
• Research the latest AI/ML/Gen AI advancements and explore technologies to enhance solution effectiveness.
• Ensure AI implementations follow healthcare regulations, ethical AI principles, and data privacy standards.
• Identify opportunities to automate workflows and optimize business processes with AI-driven solutions.