Out-of-State Provider Specialist - Onsite - West Sacramento, CA

Gainwell Technologies LLC•West Sacramento, CA

7h•$70,000 - $75,000•Onsite

About The Position

As an Out-of-State Provider Specialist 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 will 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. This is a full-time, 100% onsite role at Gainwell’s West Sacramento, California office, supporting California’s Medi-Cal program. It is not a remote or hybrid opportunity. The position involves daily collaboration with internal teams, healthcare providers, and program stakeholders, as well as managing assigned responsibilities independently in a structured office environment. Consistent onsite attendance during assigned work hours is required. This is a pipeline requisition to identify qualified candidates for anticipated future openings as business needs arise.

Requirements

High school diploma or GED.
Strong analytical, problem-solving, organizational, and time-management skills, including the ability to research discrepancies and maintain accurate records.
Excellent communication and computer skills, including proficiency with Microsoft Office applications.
Ability to work effectively in an onsite team environment.
Ability to manage assigned responsibilities independently and maintain consistent onsite attendance during assigned work hours.

Nice To Haves

Associate or bachelor's degree in healthcare administration, business, or a related field.
Experience in healthcare claims processing, provider enrollment, medical billing, Medicaid/Medi-Cal operations, or healthcare administrative support.
Knowledge of healthcare claims, provider enrollment procedures, medical billing terminology, or insurance reimbursement processes.

Responsibilities

Review, research, and correct out-of-state 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 out-of-state 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.