EDI Specialist

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You'll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.
Your role in our mission
Summary
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

• Interacts regularly with the Medicaid provider community, applying knowledge of established policies and procedures in answering inquiries, gathering information, and resolving problems and disputes in a timely and professional manner.
• Serves as an escalation point for provider requests and issues, escalating when necessary and following through to resolution and works independently and collaborates with a team and leadership to ensure exceptional customer service, alignment with business strategy and timely and successful delivery of our solutions according to customer expectations, needs, and objectives.
• Develops and maintains a solid understanding of state and federal regulatory requirements, dental claims, and applicable Medicaid programs and provides feedback and contributes to reporting to identify trends, establishing and meeting team goals and expectations, improving processes, EDI recruitment and maximizing efficiency and customer satisfaction.
• Pre-enrollment assistance; Production EDI Help Desk and support, including that for digitized attachment submission, and technical support.
• EDI testing certification (primarily conducted by the FI Systems Group (SG)) and EDI information maintenance.

What we're looking for

• A minimum of two (2) years of EDI experience
• Minimum 1 year customer service experience.
• Experience in the dental industry in provider, insurance, operations, or administration, with Medicaid and/or Medicare knowledge and experience preferred.
• Strong organizational, analytical, critical thinking, and customer service skills, along with an exceptional attention to detail.
• EDI Support staff must understand the CD-MMIS departmental organization and maintain a current knowledge of CD-MMIS functions and procedures.
• EDI Support staff must be familiar with the mainframe and an understanding of the use of Time-Sharing Option (TSO) browsing.

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 time remote work. The office is located in the Roseville/Sacramento area.
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.