Statewide Provider Relations Consultant

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 a Statewide Provider Relations Consultant at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.
 

Your role in our mission

• Assist providers with investigation of problematic claims at the point of escalation or intervention with Field Representative. 
• Monitor and keeping abreast of billing manual changes as it relates to claims processing, etc. and their impact on the provider community
• Interact with DCH employees to resolve complex issues/topics that cannot be resolved in-house
• Monitor and utilize GAMMIS and related documentation to resolve claims processing issues
• On-site training seminars and workshops, as required
• Assist with special projects as assigned by Supervisor or Manager (i.e., Call Center support or Provider Outreach)
• Resolve and follow-up on all open CTNs within 72 business hours of CTMS assignment
• Review and resolve special processing of claims (Special Batching).
• Complete a weekly status report
• Assist in the organization, implementation, and execution of 2 Medicaid fairs tentatively scheduled for April and October. 
• Accompany a Field Rep on at least four (4) on provider visits per calendar month (combination of on-site and virtual if in-person visits are not available). 
• Using the Consultant Buddy System, coach, and mentor to develop Field Reps and In-House Representatives by communicating weekly to ensure they are on the right track.
• Implement and communicate to Manager ways to create a seamless process between departments within our organization monthly.

What we're looking for

• Bachelor's degree in Business Administration or Health Services Administration (strongly preferred).
• Minimum of 1 year of experience in healthcare billing.
• 5 years of experience in healthcare public relations, or an equivalent combination of education and experience.
• Preferred: At least 2 years of experience with Medicaid claims, policies, and procedures.
• Required on-site visits to the Tucker, GA office.

What you should expect in this role

• This is a remote position; however, it will require candidates to make monthly onsite visits to our office in Tucker, GA.
• Video cameras must be used during all interviews, as well as during the initial week of orientation.

#LI-REMOTE #LI-JA1 #LI-CM1
 

The pay range for this position is $56,300.00 - $80,400.00 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 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.