Provider Field Representative – California (San Diego area)

Gainwell Technologies LLC; San Francisco (CA); Remote; USD 46,000 - 67,000; Full time

Job summary

A healthcare solutions company is seeking Provider Field Representatives to support the provider community. Candidates should have experience in medical claims processing and provider billing, strong communication skills, and the ability to deliver training. This role involves both virtual and onsite interactions, fulfilling a vital liaison function within the Medi-Cal program. Work flexibility and professional development are key aspects of this position.

Benefits

Flexible vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Qualifications

• Three or more years in medical claims processing or provider billing.
• Experience with CMS-1500 and UB-04 claim forms.
• Hands-on experience with claim submission and reimbursement processes.
• Willingness to travel within the assigned region.

Responsibilities

• Perform tasks related to provider claiming and training.
• Provide training to the provider community.
• Support provider inquiries and conduct outreach.
• Resolve provider issues while ensuring compliance.

Skills

medical claims processing

provider billing experience

analytical skills

communication skills

organizational skills

time management

Job description

Great companies need great teams to propel their operations. 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.

Summary

The Provider Field Representatives , also known as Regional Representatives, support the provider community in a variety of areas including but not limited to virtual and onsite visits, claims follow up and research support, as well as virtual and face-to-face training development and delivery. These positions act as liaisons between providers and internal departments. The appropriate individuals for these positions will possess strong communication skills, have experience delivering training in-person and virtually, and be available for limited overnight travel. These positions work with providers, provider associations, and directly with the client in support of the Medi-Cal program.

Your role in our mission

• Under minimal supervision, performs routine to complex tasks that are related to provider claiming, program policies, and training.
• Provides training (workshops, seminars, program specific group events) to the provider community and acts as liaison with our internal departments and the customer to implement programs that are necessary for the Medicaid program.
• Provides one-on-one billing support, claim research and analysis, and targeted outreach to providers; supports provider association inquiries and events
• Applies knowledge of established policies and procedures to resolve provider issues, and to work with the customer to ensure compliance.
• Exercises independent judgment within defined practices and procedures to define appropriate actions; escalates areas of concern to leadership/the client as defined by procedures; evaluates unique circumstances and makes recommendations.

What we’re looking for

• Three or more years of medical claims processing or provider billing experience , including working knowledge of CMS-1500 and UB-04 claim forms.
• Hands-on experience researching, resolving, and educating providers on claim submission, denials, and reimbursement processes ; Medi-Cal or Medicaid experience preferred.
• Strong analytical, organizational, and time management skills, with proven ability to manage multiple provider requests efficiently.
• Excellent communication, presentation, and training skills for both virtual and in-person settings, with a focus on simplifying complex billing and policy topics.
• Willingness and ability to travel within the assigned region to conduct provider visits, outreach events, and training sessions.

What you should expect in this role

• Work from Home, in the San Diego area
• Travel required throughout the assigned geographic region to support training and other provider and account needs.
• For positions assigned to WFH, reliable high-speed internet connectivity is required. Employees working-from-home may be required to report to the office, at times, to support work efforts.

LI-REMOTE #LI-LS2 #LI-CM1

The pay range for this position is $46,800.00 – $66,900.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.