calpionplutus

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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