Provider Relations Representative Hybrid Williston, VT

Gainwell Technologies LLC•Any city, OH

8d•$43,800 - $62,500•Hybrid

About The Position

The Provider Relations Representative serves as the primary liaison between Vermont Medicaid providers and Gainwell Technologies. The role builds and maintains provider relationships, delivers education, resolves complex inquiries, supports claims and billing issue resolution, and helps providers participate successfully in the Vermont Medicaid program. The representative works with State partners and teams including Provider Enrollment, Claims, Prior Authorization, EDI, and Member Services to improve the provider experience and support program objectives. The position is hybrid in Williston, Vermont. Most work is remote, with onsite attendance required for some trainings and meetings. The schedule is Monday through Friday, 8:30 a.m. to 5:00 p.m.

Responsibilities

Serve as the primary point of contact for providers within assigned provider type designations.
Respond to provider inquiries about Vermont Medicaid billing, policies, procedures, and system navigation.
Conduct outreach to onboard and engage new providers, communicate known issues, and support provider education.
Review high-denial claims weekly, analyze returned claims, and coordinate follow-up to support resolution.
Conduct virtual or onsite provider visits as requested and facilitate monthly educational webinars for providers.
Collaborate with State of Vermont agencies on provider-related tasks, initiatives, and operational needs.
Manage escalations from other Gainwell departments, ensuring timely and effective resolution.
Monitor and manage the shared provider inbox on a rotating basis, maintaining accurate documentation of interactions and resolutions.
Partner with cross-functional teams to improve provider experiences, operational efficiency, and service delivery.
Identify trends, recommend process improvements, and perform additional duties to support Provider Relations team objectives.
Perform other duties as assigned to support the Provider Relations team and organizational goals.