Out-of-State Provider Specialist - Remote California

Gainwell Technologies LLC•Any city, OH

1d•$70,000 - $75,000•Remote

About The Position

Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. As an Out-of-State Provider Specialist – Remote California at Gainwell, you will support California's Medi-Cal program by reviewing out-of-state healthcare claims, coordinating provider enrollment activities, and ensuring accurate processing in accordance with established program requirements. You'll work with healthcare providers, internal teams, and the California Department of Health Care Services (DHCS) to resolve issues, maintain accurate documentation, and support efficient claims and enrollment operations.

Requirements

High school diploma or GED required
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.
Applicants must reside in California.

Nice To Haves

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.

Responsibilities

Review, research, and correct out-of-state (OOS) healthcare claims in accordance with Medi-Cal policies, procedures, and processing requirements.
Process enrollment activities for out-of-state medical and outpatient providers, reviewing documentation for accuracy and completeness.
Evaluate provider eligibility against established OOS criteria and refer providers who do not meet applicable requirements to DHCS for enrollment processing.
Coordinate billing and enrollment materials, respond to provider inquiries, research discrepancies, and maintain accurate records and activity logs.
Track daily and weekly activities, prepare required reports, and meet established productivity, quality, and contractual requirements.