Subject Matter Expert - Credentialing (State of Indiana)

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    "description": "<p><span style=\"font-weight: bold\">Role Summary</span></p>\n<p>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. The SME works closely with clients, internal teams, and offshore credentialing partners to address complex credentialing scenarios and optimize operational outcomes specific to Indiana.</p>\n<p><br></p>\n<p><span style=\"font-weight: bold\">Core Responsibilities</span></p>\n<ul>\n<li>Act as the <span style=\"font-weight: bold\">primary Subject Matter Expert for Indiana provider credentialing</span>, including state-specific rules, timelines, and payer nuances</li>\n<li>Provide expert guidance on <span style=\"font-weight: bold\">initial credentialing, re-credentialing, and enrollment</span> for Medicare, <span style=\"font-weight: bold\">Indiana Medicaid (IHCP / Hoosier Healthwise, HIP, MCOs)</span>, and commercial payers</li>\n<li>Serve as the <span style=\"font-weight: bold\">escalation point</span> for complex Indiana credentialing cases, denials, and payer delays</li>\n<li>Interpret and apply <span style=\"font-weight: bold\">Indiana-specific regulatory and payer requirements</span> to ensure compliance and accuracy</li>\n<li>Guide offshore and internal teams on <span style=\"font-weight: bold\">Indiana Medicaid enrollment processes</span>, including MCO credentialing workflows</li>\n<li>Review provider applications and documentation for <span style=\"font-weight: bold\">state-specific completeness and accuracy</span></li>\n<li>Engage directly with <span style=\"font-weight: bold\">Indiana payer enrollment departments</span> to resolve issues and accelerate approvals</li>\n<li>Ensure provider data accuracy across <span style=\"font-weight: bold\">CAQH, PECOS, NPPES</span>, and payer portals relevant to Indiana</li>\n<li>Maintain oversight of credentialing trackers and dashboards with a focus on <span style=\"font-weight: bold\">Indiana-based providers</span></li>\n<li>Support internal and external <span style=\"font-weight: bold\">audits</span>, ensuring adherence to HIPAA and Indiana payer guidelines</li>\n<li>Collaborate with sales and client success teams to provide <span style=\"font-weight: bold\">Indiana credentialing expertise during onboarding and expansion</span></li>\n<li>Contribute to <span style=\"font-weight: bold\">process improvements, SOP development, and training materials</span> related to Indiana credentialing</li>\n</ul>\n<p><br></p>\n<p><span style=\"font-weight: bold\">Indiana-Specific Expertise</span></p>\n<ul>\n<li>In-depth knowledge of <span style=\"font-weight: bold\">Indiana Health Coverage Programs (IHCP)</span></li>\n<li>Experience with <span style=\"font-weight: bold\">Hoosier Healthwise, Healthy Indiana Plan (HIP), CareSource, Anthem Indiana, Managed Health Services (MHS), UnitedHealthcare Community Plan Indiana</span></li>\n<li>Familiarity with <span style=\"font-weight: bold\">Indiana Family and Social Services Administration (FSSA)</span> credentialing requirements</li>\n<li>Understanding of <span style=\"font-weight: bold\">Indiana Medicaid revalidation and enrollment timelines</span></li>\n<li>Expertise in Indiana-specific payer escalation paths and common enrollment bottlenecks</li>\n</ul>\n<p><br></p>\n<p><span style=\"font-weight: bold\">Required Qualifications</span></p>\n<ul>\n<li><span style=\"font-weight: bold\">10+ years of U.S. provider credentialing experience</span>, with deep hands-on expertise in <span style=\"font-weight: bold\">Indiana credentialing</span></li>\n<li>Strong working knowledge of <span style=\"font-weight: bold\">Indiana Medicaid, Medicare, and commercial payer enrollment</span></li>\n<li>Extensive experience using <span style=\"font-weight: bold\">CAQH, PECOS, NPPES</span>, and Indiana-relevant payer portals</li>\n<li>Proven ability to resolve complex credentialing issues and guide teams through escalations</li>\n<li>Excellent communication, documentation, and stakeholder management skills</li>\n</ul>\n<p><br></p>\n<p><span style=\"font-weight: bold\">Tools &amp; Systems</span></p>\n<ul>\n<li>CAQH, PECOS, NPPES</li>\n<li>OIG, SAM, Indiana Medicaid Exclusion Lists</li>\n<li>Medicare Opt-Out List</li>\n<li>Social Security Death Master File (SSDMF)</li>\n<li>Payer portals: <span style=\"font-weight: bold\">Anthem Indiana, UHC Indiana, Cigna, Humana, Indiana Medicaid MCO portals</span></li>\n<li>Credentialing dashboards and Excel-based trackers</li>\n</ul>\n<p> </p>",
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