[Hiring] Medicaid Provider Enrollment Subject Matter Expert @Accede Solutions

Role Description

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.

Qualifications

• Generally 3–6+ years in provider relations, credentialing, or enrollment, with deep knowledge of Medicaid/Medicare workflows.
• Strong understanding of Medicaid regulations, credentialing standards (NCQA), and provider compensation models (e.g., FFS, risk).
• Proficiency in provider enrollment databases, state portals, and Microsoft Office Suite.
• Bachelor's degree preferred (or equivalent work experience).