California Licensed Provider Specialist

Job Summary

Supporting California's Medi-Cal program, the full-time Out-of-State Provider Specialist will review out-of-state healthcare claims, coordinate provider enrollment activities, and ensure accurate processing while working remotely from California.

Key responsibilities

• Review, research, and correct out-of-state healthcare claims in accordance with Medi-Cal policies
• Process enrollment activities for out-of-state medical and outpatient providers, ensuring documentation accuracy
• Evaluate provider eligibility against established criteria and coordinate with DHCS for enrollment processing

Required qualifications

• High school diploma or GED required; an associate or bachelor's degree in healthcare administration or related field is a plus
• Experience in healthcare claims processing, provider enrollment, or Medicaid/Medi-Cal operations preferred
• Knowledge of healthcare claims and provider enrollment procedures preferred
• Strong analytical and organizational skills with the ability to maintain accurate records
• Proficiency in Microsoft Office applications and ability to work independently in a remote environment