Remote Medi-Cal Provider Claims & Enrollment Specialist

Gainwell Technologies; California; Remote; USD 70,000 - 75,000; Full time

Job summary

Gainwell Technologies, in a fully remote California role, seeks an Out-of-State Provider Specialist to support Medi-Cal by reviewing out-of-state claims and coordinating enrollment. You will work with providers, internal teams, and DHCS to resolve issues, maintain documentation, and ensure accurate processing in line with program requirements.

This full-time, 100% remote position requires a California resident with strong analytical and communication skills; salary ranges from $70k to $75k, with

Qualifications

• High school diploma or GED required; degree in healthcare administration or related field is a plus.
• Experience in healthcare claims processing, provider enrollment, medical billing, or Medicaid/Medi-Cal operations preferred.
• Knowledge of healthcare claims, provider enrollment procedures, medical billing terminology, or insurance reimbursement processes preferred.
• Strong analytical, problem-solving, organizational, and time-management skills.
• Excellent communication and computer skills; ability to work independently in a remote environment.

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 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.

Skills

Healthcare claims experience

Provider enrollment experience

Analytical skills

Communication skills

MS Office proficiency

Remote work capability

Education

High school diploma or GED

Associate or bachelor's degree in healthcare administration or related field (preferred)

Tools

Microsoft Office

Job description

Gainwell Technologies, in a fully remote California role, seeks an Out-of-State Provider Specialist to support Medi-Cal by reviewing out-of-state claims and coordinating enrollment. You will work with providers, internal teams, and DHCS to resolve issues, maintain documentation, and ensure accurate processing in line with program requirements.

This full-time, 100% remote position requires a California resident with strong analytical and communication skills; salary ranges from $70k to $75k, with