Subject Matter Expert - Credentialing (State of Indiana)

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