About this opportunity
Calpion/Plutus Health lists this Subject Matter Expert - Credentialing (State of Indiana) opportunity in dallas, Texas. Review the employer’s description below for duties, qualifications and application requirements.
Job description
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
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Worksite address
dallas, TX, 75215, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.