Senior Healthcare QA Rep - Remote Ohio

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible.

About the role

Gainwell Technologies is seeking an experienced Sr. Healthcare Quality Assurance professional to support quality assurance, auditing, and financial operations within a healthcare environment. This role combines healthcare knowledge, financial and operational auditing, data analysis, and hands-on SQL experience to evaluate processes, identify discrepancies, ensure compliance, and support continuous improvement.

The ideal candidate brings strong analytical skills, healthcare industry experience, knowledge of medical terminology, and the ability to independently research and resolve complex operational and financial issues. This position is remote within Ohio with required onsite attendance at our Ohio office approximately 2 times per month; onsite frequency may vary based on business needs.

Responsibilities

• Perform quality assurance and audit activities across healthcare financial operations, including accounts receivable/payable, capitation, credit balances, cost settlements, recoveries, and related processes.
• Review financial transactions, healthcare data, reports, and supporting documentation to identify discrepancies and ensure accuracy and compliance with established controls.
• Use SQL to query, extract, review, and analyze data in support of audits, reporting, research, reconciliation, and operational analysis.
• Create, maintain, and update audit procedures, control documentation, operational processes, and client-required reporting.
• Research complex financial and operational issues, recommend process improvements, and serve as a resource to team members on quality, audit, and operational requirements.

Requirements

• Bachelor’s degree or equivalent combination of education and relevant professional experience in quality assurance, auditing, finance, accounting, financial analysis, or a related function.
• Healthcare industry experience, preferably within Medicaid, Medicare, managed care, health insurance, claims, or government healthcare programs.
• One to two years of hands-on SQL experience, including querying, extracting, reviewing, and analyzing data.
• Working knowledge of medical terminology with experience interpreting healthcare-related data, claims, documentation, and operational information.
• Knowledge of financial controls and accounting principles, including GAAP and/or SOX, with strong analytical, research, problem-solving, and communication skills.

Benefits

• Comprehensive benefits for eligible employees, including medical, dental, and vision coverage.
• Access to a 401(k) retirement savings plan and additional employee wellness and financial benefits.
• Paid time off and paid holidays to support work-life balance.
• Opportunities for professional development and career growth within Gainwell Technologies.
• Generous, flexible vacation policy for salaried, full-time candidates.
• 401(k) employer match.
• Educational assistance.
• Variety of leadership and technical development academies to help build your skills and capabilities.

Pay

The pay range for this position is $50,400.00 - $72,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

Schedule

This position is remote within Ohio with required onsite attendance at our Ohio office approximately 2 times per month; onsite frequency may vary based on business needs.