calpionplutus
Subject Matter Expert - Credentialing (State of Indiana)
Dallas, Texas
Sponsorship not specifiedDetected 20 days ago
ComplianceStakeholder ManagementExcelHIPAACommunication
About the role
- Role Summary The Subject Matter Expert (SME) - Provider Credentialing (Indiana) serves as the authoritative resource for all credentialing, re-credentialing, and enrollment activities within the state of Indiana.
- This role provides strategic guidance, issue resolution, and subject expertise across Medicare, Indiana Medicaid, and commercial payers, ensuring regulatory compliance, payer alignment, and timely provider onboarding.
Responsibilities
- The SME works closely with clients, internal teams, and offshore credentialing partners to address complex credentialing scenarios and optimize operational outcomes specific to Indiana.
- Maintain oversight of credentialing trackers and dashboards with a focus on Indiana-based providers
- Support internal and external audits, ensuring adherence to HIPAA and Indiana payer guidelines
- Collaborate with sales and client success teams to provide Indiana credentialing expertise during onboarding and expansion
Requirements
- 10+ years of U.S. provider credentialing experience, with deep hands-on expertise in Indiana credentialing
- Strong working knowledge of Indiana Medicaid, Medicare, and commercial payer enrollment
- Proven ability to resolve complex credentialing issues and guide teams through escalations
- Required Qualifications
Benefits
- In-depth knowledge of Indiana Health Coverage Programs (IHCP)
- Experience with Hoosier Healthwise, Healthy Indiana Plan (HIP), CareSource, Anthem Indiana, Managed Health Services (MHS), UnitedHealthcare Community Plan Indiana
Visa & Work Authorization
- Medicare Opt-Out List
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