What are the responsibilities and job description for the Plan and Provider Specialist position at Gainwell Technologies LLC?
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
Provides quality training and education to the Florida Medicaid provider and health plan communities both virtually and onsite, as required. Knowledgeable in claims processing and adjudication, Medicaid policy, enrollment processes, and health plan policies and procedures. Receives incoming inquiries from a variety of sources, including email, call center escalations, the Agency, and the public Web Portal. Responds quickly and professionally to Agency, provider, and health plan inquiries with resolutions to problems/issues that may require extensive research. Coordinates with other departments regarding identified system issues and follows through to resolution; this may include, but is not limited to enrollment, claims, and EDI issues. Meets regularly with leadership to review status of escalations/inquiries to ensure timely responses. Performs other duties as assigned.
Your role in our mission
- Provider Outreach: Provide outreach and training for all newly enrolled providers. Educate existing providers on system changes, claims submission/processing issues, and Medicaid policy. Outreach is conducted virtually, or onsite as approved by leadership. Lead public presentations and provider workshops as needed. Effective verbal and written communication skills with providers, health plans, and internal teams.
- Health Plan Outreach: Monitor Health Plan Support email box. Promptly assist with health plan inquiries and meeting requests. Participate in Health Plan Summits as needed
- Documentation: Collaborate with development of training and educational materials for providers. This includes reviewing QRGs/Tip Sheets, updates to the Known Issues list, FAQs, and training presentations posted on the public Web Portal.
- Escalations: Assist call center and provider enrollment staff with more complicated inquiries. Review Health Plan Support mailbox and participate in Health Plan meetings as assigned. All escalations should be completed within established timeframe.
- Operational Review: Participate in the identification, documentation, analysis and validation of basic business processes, systems, and solution requirements.
What we're looking for
- Preferred minimum of 2 years of experience in client services, provider relations, and claims processing.
- Knowledge and understanding of Medicaid, claims processes and data capturing.
- Proficiency in creating presentations, training documents, reports, and analytical graphs.
- Training/teaching onsite or remotely (webinar or similar tools), Experience working with claims preferred
- Ability to work independently and as part of a team
What you should expect in this role
- Hybrid (Both remote and office)
- Occasional travel may be required
- LI -HYBRID
- #LI-LS2
The pay range for this position is $42,100 - $60,100 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 committed to a diverse, equitable, and inclusive workplace. We are proud to be 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), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.
Salary : $42,100 - $60,100
