AS
Medicaid Provider Enrollment Subject Matter Expert (SME)
Accede Solutions Inc
Location not stated
Remote
6 months ago
6 months ago
Duration: 12+ months
Location: Remote
Job Summary:
A Medicaid Provider Enrollment Subject Matter Expert (SME) ensures healthcare providers are properly credentialed, contracted, and enrolled in government-sponsored health plans. Responsibilities include managing complex enrollment applications, ensuring compliance with Medicaid/Medicare policies, auditing data, and acting as a lead contact for state enrollment systems.
Key Responsibilities
- Enrollment & Credentialing: Managing and submitting accurate, timely applications to state Medicaid agencies and managed care organizations.
- Policy Expertise: Ensuring compliance with federal and state regulations regarding Medicaid provider enrollment, including Fee-for-Service (FFS) and managed care.
- System Auditing & Support: Supporting audits of enrollment applications, remediating data quality issues, and assisting with data mapping or provider enrollment system updates.
- Relationship Management: Working with providers, clinics, and state agencies to resolve enrollment roadblocks.
- Experience: Generally 3–6+ years in provider relations, credentialing, or enrollment, with deep knowledge of Medicaid/Medicare workflows.
- Knowledge: Strong understanding of Medicaid regulations, credentialing standards (NCQA), and provider compensation models (e.g., FFS, risk).
- Technical Skills: Proficiency in provider enrollment databases, state portals, and Microsoft Office Suite.
- Education: Bachelor's degree preferred (or equivalent work experience)
Medicaid Provider Enrollment Subject Matter Expert (SME) · Accede Solutions Inc