Call Center Agent – Provider Lead EDI

🕒 September 15

🏄 California – Remote

🏄 California – Remote

💵 $35.9k - $51.3k / year

⏰ Full Time

🟠 Senior

📞 Call Center Representative

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Provide technical support to healthcare providers, billing offices, and trading partners regarding Provider Portal and EDI functionality • Investigate EDI transaction issues involving claim submissions, claim acknowledgments, eligibility requests (270/271), claim status requests (276/277), remittance transactions (835), and enrollment requests • Support providers and trading partners with EDI enrollment, testing, setup, and connectivity requirements • Analyze EDI rejections, edits, and error reports to determine root causes and provide resolution guidance • Research provider and submitter calls and inquiries and respond to appropriate parties in accordance with service level agreements (SLAs) • Document interactions, troubleshooting steps, resolutions, and escalations in the CRM ticketing solution

🎯 Requirements

• Knowledge of healthcare claims processing and provider operations • Understanding of HIPAA-compliant EDI transactions (837, 835, 270/271, 276/277, 278) strongly preferred • Experience supporting web-based applications, provider portals, or healthcare technology platforms • Ability to interpret EDI files, rejection reports, and transaction acknowledgments • Strong analytical, troubleshooting, and problem-solving skills • Excellent verbal and written communication skills • Experience using ticketing and customer relationship management (CRM) systems • Strong customer service orientation with a focus on provider satisfaction and issue resolution • Ability to work independently and follow oral and written instructions • Ability to navigate Microsoft Word, Microsoft Teams, Microsoft Outlook, and internet browsers • Must be able to work remotely in California; location listed as West Sacramento, California

🏖️ Benefits

• Work flexibility • Learning and career development • Generous, flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies • Equal opportunity employment