Prior Authorization Specialist - Remote US

About the role

Gainwell Technologies is seeking a Remote Prior Authorization Specialist to process Medicaid Prior Authorization (PA) requests efficiently and accurately. This role involves reviewing and processing PA requests submitted via fax, portal, phone, or mail, ensuring compliance with Medicaid policies, and collaborating with clinical teams and state employees to meet strict deadlines.

The ideal candidate is detail-oriented, can handle high-volume workloads with minimal errors, and provides excellent customer service to Medicaid providers.

Responsibilities

• Process 500+ Prior Authorization requests per week while maintaining accuracy and compliance.
• Ensure PA requests align with Medicaid policies and procedures.
• Collaborate with the clinical team to ensure timely and accurate processing of PA requests.
• Communicate effectively with Medicaid providers regarding PA status and requirements.
• Work closely with Gainwell and State employees to facilitate smooth authorization processing.

Requirements

• Relevant experience in prior authorization processing, Medicaid policy, insurance, or pharmacy.
• Strong knowledge of Medicaid policies and prior authorization procedures (preferred).
• Excellent written and verbal communication skills with strong customer service abilities.
• Ability to multitask, manage time effectively, and meet strict deadlines in a remote setting.
• Proficiency in Microsoft Office and PC-based applications, with 50-60+ WPM typing speed preferred.

What to expect

• A fast-paced, deadline-driven environment where accuracy and efficiency are essential.
• Regular interaction with providers, clinical teams, and state employees.
• A role that requires strong attention to detail and problem-solving skills.
• Opportunities to enhance Medicaid knowledge and contribute to healthcare services.
• A supportive team environment focused on quality and compliance.

Pay

The pay range for this position is $30,500.00 - $43,500.00 per year. The base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

Benefits

• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Leadership and technical development academies to help build your skills and capabilities.