Out-of-State Provider Specialist - Onsite - West Sacramento, CA

Out-of-State Provider Specialist - Onsite - West Sacramento, CA

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 As an Out-of-State Provider Specialist Onsite West Sacramento, CA at Gainwell, you will support California's Medi-Cal program by reviewing out-of-state healthcare claims, coordinating provider enrollment activities, and ensuring accurate processing in accordance with established program requirements. You'll work with healthcare providers, internal teams, and the California Department of Health Care Services (DHCS) to resolve issues, maintain accurate documentation, and support efficient claims and enrollment operations. This position requires working onsite at our West Sacramento, California office.

Your role in our mission Review, research, and correct out-of-state (OOS) 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.

What we're looking for High school diploma or GED required; an associate or bachelor's degree in healthcare administration, business, or a related field is a plus. Experience in healthcare claims processing, provider enrollment, medical billing, Medicaid/Medi-Cal operations, or healthcare administrative support 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 with the ability to research discrepancies and maintain accurate records. Excellent communication and computer skills, including proficiency with Microsoft Office applications and the ability to work effectively in an onsite team environment.

What you should expect in this role 100% onsite position located in West Sacramento, California. This is not a remote or hybrid opportunity. Full-time position supporting California's Medi-Cal program. Daily collaboration with internal teams, healthcare providers, and program stakeholders. Ability to manage assigned responsibilities independently while working in a structured office environment. Consistent onsite attendance during assigned work hours is required. This is a pipeline requisition to identify qualified candidates for anticipated future openings as business needs arise.

The pay range for this position is $41,600 - $44,500 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.