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. The SME works closely with clients, internal teams, and offshore credentialing partners to address complex credentialing scenarios and optimize operational outcomes specific to Indiana.
Core Responsibilities
- Act as the primary Subject Matter Expert for Indiana provider credentialing, including state-specific rules, timelines, and payer nuances
- Provide expert guidance on initial credentialing, re-credentialing, and enrollment for Medicare, Indiana Medicaid (IHCP / Hoosier Healthwise, HIP, MCOs), and commercial payers
- Serve as the escalation point for complex Indiana credentialing cases, denials, and payer delays
- Interpret and apply Indiana-specific regulatory and payer requirements to ensure compliance and accuracy
- Guide offshore and internal teams on Indiana Medicaid enrollment processes, including MCO credentialing workflows
- Review provider applications and documentation for state-specific completeness and accuracy
- Engage directly with Indiana payer enrollment departments to resolve issues and accelerate approvals
- Ensure provider data accuracy across CAQH, PECOS, NPPES, and payer portals relevant 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
- Contribute to process improvements, SOP development, and training materials related to Indiana credentialing
Indiana-Specific Expertise
- 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
- Familiarity with Indiana Family and Social Services Administration (FSSA) credentialing requirements
- Understanding of Indiana Medicaid revalidation and enrollment timelines
- Expertise in Indiana-specific payer escalation paths and common enrollment bottlenecks
Required Qualifications
- 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
- Extensive experience using CAQH, PECOS, NPPES, and Indiana-relevant payer portals
- Proven ability to resolve complex credentialing issues and guide teams through escalations
- Excellent communication, documentation, and stakeholder management skills
Tools & Systems
- CAQH, PECOS, NPPES
- OIG, SAM, Indiana Medicaid Exclusion Lists
- Medicare Opt-Out List
- Social Security Death Master File (SSDMF)
- Payer portals: Anthem Indiana, UHC Indiana, Cigna, Humana, Indiana Medicaid MCO portals
- Credentialing dashboards and Excel-based trackers
