Medical Management Prior Authorization (PA) call center

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 Medical Management Prior Authorization (PA) call center handles Nevada Medicaid calls related to prior authorizations, level of care determinations, Pre-admission screening and resident reviews (PASRR) screenings, and personal care service intakes. The call center staff also complete supported tasks outside of answering calls such as PASRR portal issues, email inquiries, and limited provider appeal processes. The call center representatives work to resolve caller issues and concerns and escalate as appropriate to the prior authorization voicemail lines for the specific authorization type, or to management for follow up.

Your role in our mission

This is an important position in Gainwell’s commitment to helping clients deliver better health and human services outcomes.

• Provide knowledgeable responses to basic client questions; elevate more complex cases to appropriate staff as needed
• Put your skills to work to solve client problems, update account history and follow up with clients to confirm their inquiry or request is resolved
• Adhere to the client’s SLAs and consistently meet production targets
• Collaborate with team members, management and clients to resolve client inquiries; cross-train new resources in customer service processes
• Process client inquiries more efficiently and effectively by reviewing and recommending changes to procedures and workflow

What we’re looking for

• 2 or more years of customer service experience in any industry
• Knowledge of basic help desk software, computer software and Microsoft Office applications
• Strong problem-solving skills to bring inquiries to effective resolution
• Strong customer service skills with an emphasis on written and oral communication to respond to inquiries professionally
• Ability to understand your role on a team and identify the correct stakeholders to consult to resolve client inquiries

What to expect in this role

• Office environment expectation in a remote work from home location. May require commuted to closest Gainwell office for IT support or equipment pick up.
• Candidates must be available to work an 8-hour shift until 5pm Pacific, Monday through Friday.
• The call center operates M-F, 8 am to 5 pm PST. In addition to the Gainwell required background check. Nevada requires an additional FBI/fingerprint background check.
• #LI-REMOTE
• #LI-LS2
• Video cameras must be used during all interviews, as well as during the initial week of orientation.

The pay range for this position is $29,100 – $41,600 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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