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Gainwell Technologies · 2 weeks ago

Provider Claims Training Specialist - San Diego, CA - Remote

United States

Full-time

Remote

Mid Level

$50K/yr - $70K/yr

3+ years exp

Gainwell Technologies is a company that values contributions and promotes work flexibility, learning, and career development. The Provider Claims Training Specialist supports the provider community through training, claims follow-up, and acting as a liaison between providers and internal departments, primarily focusing on the Medi-Cal program.

Health CareInformation Technology

Hiring Manager

Craig Murphy

Responsibilities

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

Qualification

Medical claims processingProvider billing experienceTraining developmentCMS-1500 knowledgeUB-04 knowledgeAnalytical skillsCommunication skillsOrganizational skillsTime managementPresentation skills

Required

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