[Hiring] Out-of-State Provider Specialist @Gainwell Technologies LLC

Role Description

As an Out-of-State Provider Specialist – Remote California at Gainwell, you will support California's Medi-Cal program by:

• Reviewing, researching, and correcting out-of-state (OOS) healthcare claims in accordance with Medi-Cal policies, procedures, and processing requirements.
• Processing enrollment activities for out-of-state medical and outpatient providers, reviewing documentation for accuracy and completeness.
• Evaluating provider eligibility against established OOS criteria and referring providers who do not meet applicable requirements to DHCS for enrollment processing.
• Coordinating billing and enrollment materials, responding to provider inquiries, researching discrepancies, and maintaining accurate records and activity logs.
• Tracking daily and weekly activities, preparing required reports, and meeting established productivity, quality, and contractual requirements.

Qualifications

• High school diploma or GED required; an associate or bachelor's degree in healthcare administration, business, or a related field is a plus.
• Experience in healthcare claims processing, provider enrollment, medical billing, Medicaid/Medi-Cal operations, or healthcare administrative support preferred.
• Knowledge of healthcare claims, provider enrollment procedures, medical billing terminology, or insurance reimbursement processes preferred.
• Strong analytical, problem-solving, organizational, and time-management skills with the ability to research discrepancies and maintain accurate records.
• Excellent communication and computer skills, including proficiency with Microsoft Office applications and the ability to work independently in a remote environment.

Requirements

• 100% remote position. Applicants must reside in California.
• Full-time position supporting California's Medi-Cal program.
• Ability to work independently while collaborating with internal teams and healthcare providers.
• Reliable high-speed internet access and a private, professional workspace are required.
• This is a pipeline requisition to identify qualified candidates for anticipated future openings as business needs arise.

Benefits

• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Leadership and technical development academies to help build your skills and capabilities.