Payment Integration Product Solution Architect

Summary

As a Payment Integration Product Solution Architect 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.

About the role

HMS, a Gainwell Technologies company, is seeking an experienced Payment Integrity Product Solution Architect to manage process and requirement gathering for Payment Integrity product implementations. This role is responsible for client communications, requirement documentation and sign-off, interaction and facilitation with internal stakeholders for internal platform development and successful deployment.

Responsibilities

• Support Director of Implementation driving Payment Integrity growth strategy, accelerating implementation and revenue recognition, and implementation staff development
• Oversee multiple projects, providing mentorship and guidance to implementation team members ensuring departmental guardrails are being met timely and accurately
• Training, quality assurance, and development of departmental guides and standard operating procedures
• Rapid escalation and problem solving of client project customizations, issues, and delays of project portfolio
• New product deployment and operational readiness plans documenting and execution of platform builds
• Interfaces across multiple applications areas to ensure that the appropriate platform capabilities and functionalities are accounted for in the product process design
• Facilitate and lead client product design discussions
• Obtain, document, and finalize all aspects of client and HMS product process design, file requirements, and other items related to the Payment Integrity product suite
• Ensures the adherence to standards and guidelines set forth in the Payment Integrity product and implementation guardrails
• Communicate raw data source product requirements to the client and facilitate internal analysis partnering with the HMS data team
• Work with IT Application, Implementation, and Operations team members to confirm and/or develop requirements specifications for product implementation or new application functionality and customizations
• Maintain documentation and crucial artifacts required for an implementation and any applicable hand-off to Operations
• Partners and provides assistance, as needed, with the Implementation Project Management Team, Account Management, and IT
• Acts as an internal consultant, advocate, and mentor
• Tracks, reports, and acts on applicable internal metrics for Implementation activities
• Works with key business leaders to ensure alignment of product and platform features and capabilities

Requirements

• 8+ years of experience in Payment Integrity Audit and Recovery with knowledge of audit strategies such as Data Mining, Clinical Medical Record Review, COB, and Bill Audit
• 8+ years of experience in healthcare, preferably a claim payment or audit recovery environment
• 8+ years of external client facing experience
• 4+ years working collaboratively with Information Technology and multiple organizational departments
• Experience with MS Project, Visio and MS Office Products
• Experience with new product deployment and operational readiness plans documenting and execution of platform builds
• Experience in requirements gathering, systems integrations, data onboarding, process flow design and project management
• Ability to present and communicate ideas clearly and persuasively at all levels to both internal and external audience

Qualifications

• BS/BA degree in Computer Science, Information Systems, or related field
• Experience with healthcare software development and integration
• Strong understanding of healthcare regulations and compliance
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team

Skills

• Strong analytical and problem-solving skills
• Excellent project management and time management skills
• Proficient in MS Project, Visio, and MS Office products
• Experience with healthcare software development and integration
• Knowledge of healthcare regulations and compliance

Benefits

• Comprehensive health benefits
• Flexible vacation policy
• 401(k) employer match
• Opportunities to travel through your work (0-10%)
• Video cameras must be used during all interviews, as well as during the initial week of orientation

Pay

The pay range for this position is $95,100.00 - $135,800.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.