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. You'll 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 The
Provider Field Representative, supports the provider community in a variety of areas including but not limited to virtual and onsite visits, claims follow up and research support, as well as virtual and face-to-face training development and delivery. These positions act as liaisons between providers and internal departments. The appropriate individuals for these positions will possess complex claims resolutions, strong communication skills, have experience delivering training in-person and virtually, and be available for local travel in the DC metropolitan area. These positions work with providers, provider associations, and directly with the client in support of the District's Medicaid programs.
Your role in our mission - Under minimal supervision, performs routine to complex tasks that are related to provider claiming, program policies, and training.
- Provides training (workshops, seminars, program specific group events) to the provider community and acts as liaison with our internal departments and the customer to implement programs that are necessary for the Medicaid program.
- Provides one-on-one billing support, claim research and analysis, and targeted outreach to providers; supports provider association inquiries and events. Act as an escalation point for internal claims staff.
- Liaise with internal departments and the client to ensure that all provider concerns are resolved in a timely and efficient manner.
- Applies knowledge of established policies and procedures to resolve provider issues, and to work with the customer to ensure compliance.
- Exercises independent judgment within defined practices and procedures to define appropriate actions; escalates areas of concern to leadership/the client as defined by procedures; evaluates unique circumstances and makes recommendations.
What we're looking for - Three or more years of working in a provider relations or provider contracting role for a health plan in Medicaid or Medicare. Medicaid experience preferred.
- Solid understanding of provider operations and key business transactions from a health plan, provider group, or government regulatory perspective.
- Experience working with medical claims processing and claims resolution.
- Strong analytical skills and provider relations skills.
- Excellent communication, presentation, and facilitation skills. Some training experience preferred.
- Experience working with business processes. Ability to assess clients' business and identify improvement opportunities.
- Ability to conceptualize, develop, and apply business and management consulting applications and services.
- Willingness and ability to travel in the DC Metro area as needed.
What you should expect in this role - Strong account management skills to ensure assigned providers or provider communities receive rapid, personalized support for their most pressing needs.
- Experience in provider relations, provider training, provider contracting, claims, or a provider?facing role within a Medicaid or Medicare health plan. Medicaid experience preferred. Experience in billing or claims within a health plan or medical group is highly valued.
- Experience with professional and institutional claims at a detailed level, along with familiarity with claims IT systems and interfaces. Ability to independently perform basic and intermediate research.
- Understanding of provider operations and key business processes from a health plan, provider group, or regulatory perspective.
- Experience with complex medical claims processing and claims resolution. Advanced knowledge of claims and other aspects of managed care.
- Strong analytical and provider?relations skills. Ability to develop Excel reports and perform Excel?based analysis.
- Excellent communication, presentation, and facilitation skills. Training experience preferred, including strong virtual communication and training capabilities.
- Ability to compose, present and direct provider trainings, analysis, and management-level communications with limited support.
- Work from Gainwell's office in downtown DC, and onsite at provider locations in the DC Metro area.
- Travelling to provider, client, or relevant meetings with up to 5% local travel
- Work standard business hours Monday through Friday, 8:00 AM to 5:00 PM EST. Occasional flexibility may be required to accommodate provider schedules or special events.
The deadline to submit applications for this posting is 09/30/26.The pay range for this position is $51,700.00 - $73,800.00 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 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.
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