Appeals Representative - Roseville, CA - Hybrid

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. Youll 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

Put your passion to work and grow your career by learning from healthcare innovators and mentors. By joining our team, youll work with industry pioneers who do incredible things to move healthcare forward.

From day one, youll work on exciting projects that make a meaningful impact on peoples lives. Youll also have incredible opportunities to learn and develop your skills by joining a collaborative team that celebrates and embraces our differences.

We have comprehensive leadership and technical development academies to help build your skills and fulfill your career aspirations.

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 communitys most vulnerable.

Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcares biggest challenges.

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 researching and analyzing incoming Provider First Level Appeal requests, determining proper procedures to follow, creating supporting documentation, processing claims / TARs on final determinations, and communicating with providers and DHCS.

Your role in our mission

Research Provider First Level Appeals and obtain additional information, if needed. Analyses documents and decides on how to proceed to provide a document reevaluation.

Creates documentation supporting the determination and forwarding information to consultants as needed.

• Processes claims and TARs based on the final determination. Regular updating, tracking, and monitoring of extensive caseload in the CRM system.
• Regular communication with the providers and DHCS to ensure the appeals are concluded successfully and accurately.
• Handle miscellaneous Provider Correspondence and requests. Adhere to all required service-level agreements.
• Provide support for all member and provider correspondence functions.

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 1-2 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 $32,600.00 - $46,500.00 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. Youll 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 , and educational assistance.

We also have a variety of leadership and technical development academies to help build your skills and capabilities.