Provider Enrollment Specialist - Remote US

Summary

Provider Enrollment Specialists work as the enrollment liaison between Gainwell Technologies, Idaho Department of Health & Welfare (Medicaid Division) and the Idaho Medicaid provider community (direct physicians, groups, organization administrators, compliance officers, billers, and credentialing staff). This position is responsible to educate, support and validate achievement of outlined enrollment requirements and process initial and maintenance applications. Requirements of this role include delivering the highest quality end-to-end service and support, by concise communications, through analysis and adherence to timely response deliverables. Specialists provide, build, maintain, and promote positive relationships through a vast array of consistent engagements with key stakeholders.

Your role in our mission

• Review and process initial provider enrollment applications per State requirements
• Updates provider changes, certifications, and license updates
• Navigates multiple systems, licensing and medical certification websites to obtain updates
• Follows up with providers on outstanding issues within contractual guidelines
• Provides excellent customer service with professional verbal and written abilities while meeting documented quality standards

What we're looking for

• Highly motivated self-starter with 3+ years’ experience working in healthcare industry preferably credentialling or regulatory.
• Strong Microsoft Office skills and experience working with business solutions software.
• Proven experience with issue resolution focused on research, provider enrollment, requirement compliance and customer service highly preferred.
• Ability to investigate complex inquiries while leveraging requirements to promote successful outcomes.
• Strong written and verbal communication skills. Strong computer and business solutions software skills. Proficient knowledge of Microsoft Office. Strong organization and time management skills

What you should expect in this role

• This is a 100% remote position with 8-hour shifts scheduled Monday through Friday during standard business operating hours.

• Fast-paced, high-volume, highly visible role requiring strong attention to detail while delivering documented, high-quality analytical support within established service level agreement (SLA) timelines and operational standards.

• Utilize claims systems, reporting tools, and operational documentation to review pharmacy claims, validate reimbursement logic, and support claims accuracy and process improvement initiatives.

• Investigate complex inquiries, communicate findings and resolutions to internal and external stakeholders via secure messaging, email, or verbal communication, and document all activity within designated system tools.

• Work both independently and collaboratively with cross-functional teams while supporting operational goals and performance expectations.

• Eligible employees may participate in Gainwell’s comprehensive benefits program, which includes medical, dental, vision, 401(k), paid time off, and other employee wellness and support programs.
  

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