Provider Enrollment Specialist - Remote US (Any city, TX, US, 99999)

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

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.

This posting is intended for pipelining. We will accept applications on an ongoing basis.

The pay range for this position is [[salaryMin]] - [[salaryMid]] 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 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), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

Originally posted on Himalayas