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
As Correspondence Specialist, 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. Gainwell empowers you to help clients deliver better health and human services outcomes using innovative technology and solutions, enabling you to design your career for growth, new possibilities, and refinement of your valuable skills. This position is responsible for but is not limited to, researching, and analyzing incoming Member Complaints, Member Reimbursement requests, Billing and Enrollment inquiries, miscellaneous member correspondences, etc. determining appropriate paths to follow, creating supporting documentation, processing claims/TARs on final determinations, and extensive communication with members, providers, and additional internal and external customers.
Your role in our mission
- Researches member appeals and grievances, obtains additional information, analyses documents and determines how to proceed to provide a reevaluation.
- Creates documentation supporting the determination and forwards information to consultants as needed.
- Processes claims and TARs based on the final determination from Complaints and regular updating, tracking, and monitoring of extensive caseload in the CRM system.
- Regular communication with both internal and external customers to ensure the appeals and reimbursement claims are concluded successfully and accurately.
- Handles miscellaneous Member Correspondence and requests; Adhere to all required service-level agreements and provide support for all provider correspondence functions when needed.
What we're looking for
- Medi-Cal Dental Program experience needed. Claim/TAR processing preferred. Knowledge of Medi-Cal Dental policies, TARs/claims, eligibility, etc.
- A minimum of 1-2 years of related work experience.
- Dental x-ray license needed. Must be able to fluently read dental radiographs. Graduation from an accredited dental assistant school or dental office experience preferred.
- Strong organizational, analytical, and critical thinking skills are essential. Exceptional attention to detail. Excellent customer service skills; fluency in communicating dental terminology. Ability to maintain confidentiality, follow up on commitments on a timely basis, and adhere to strict deadlines. Strong team player a must.
- Formal writing skills are required. Knowledge and application of English grammar including composition, editing, and proofreading skills. Proficiency in MS Office Skills (Outlook, Word, Excel) and Adobe Acrobat required.
What you should expect in this role
- Must be a resident of the state of California.
- Hybrid work environment 3 days a week in the office as needed for face-to-face and client meetings with the remainder of the time remote work. The office is located in the Roseville/Sacramento area.
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The pay range for this position is $37,500.00 - $53,500.00 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.
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