Medi-Cal Dental Appeals Analyst

Gainwell Technologies; Roseville (CA); Hybride; USD 47 000 - 67 000; Plein temps

Avantages offerts par ce poste

401(k) match

Health benefits

Generous PTO

Résumé du poste

Gainwell Technologies is seeking a State Hearing Analyst to support Medi-Cal Dental appeals, reviewing denial information and member records. You will work with ACMS, MEDS, CD-MMIS, and EIMS to ensure accurate documentation and compliance.

The role emphasizes problem-solving, analytical thinking, and exceptional customer service as you navigate multiple systems and communicate clearly with members and providers.

Qualifications

• Experience reviewing Medi-Cal Dental appeals.
• Must be able to read X-rays.
• Strong written and verbal communication skills.
• Excellent organization, analytical, and problem-solving abilities.
• Ability to manage multiple tasks and navigate several systems simultaneously.

Responsabilités

• Retrieve and review new Medi-Cal Dental appeals, researching denial information and member records.
• Prepare radiograph requests and obtain missing information from providers and members.
• Draft Conditional Withdrawal letters and Position Statements while ensuring HIPAA compliance, case accuracy, and completeness.
• Manage appeals throughout the full case lifecycle by monitoring caseloads and coordinating required next steps.
• Serve as the primary point of contact for members after hearing requests, explaining outcomes and procedures.

Connaissances

Analytical thinking

Written communication

Verbal communication

Microsoft Word

Microsoft Excel

HIPAA compliance

Outils

ACMS

MEDS

CD-MMIS

EIMS

Description du poste

Gainwell Technologies is seeking a State Hearing Analyst to support Medi-Cal Dental appeals, reviewing denial information and member records. You will work with ACMS, MEDS, CD-MMIS, and EIMS to ensure accurate documentation and compliance.

The role emphasizes problem-solving, analytical thinking, and exceptional customer service as you navigate multiple systems and communicate clearly with members and providers.