Senior Provider Enrollment Specialist Hybrid Warwick, RI

Gainwell Technologies LLC•Warwick, RI

3d•$43,800 - $62,500•Hybrid

About The Position

The Senior Provider Enrollment Specialist is responsible for supporting provider enrollment and screening activities for the Rhode Island Medicaid Program. This role ensures the accurate and timely processing of provider enrollment applications in compliance with Rhode Island Medicaid policies, Affordable Care Act (ACA) requirements, and applicable federal regulations. The specialist maintains provider records, responds to enrollment-related inquiries, and collaborates closely with Gainwell Technologies and State Medicaid representatives to ensure program integrity and operational excellence.

Requirements

Excellent customer service, interpersonal, written communication, and computer skills, with proficiency in Microsoft Office and Windows-based systems.
Strong attention to detail and ability to maintain accuracy, confidentiality, and sound judgment when handling sensitive provider information.
Ability to conduct independent research, evaluate information, interpret and apply policies, procedures, government regulations, and healthcare guidelines, and make informed decisions.
Strong organizational, time management, and prioritization skills, with the ability to adapt to changing priorities in a fast-paced environment.
Self-motivated and able to work independently and collaboratively while maintaining productivity and supporting team goals.
Ability to read, write, and communicate effectively in English.

Nice To Haves

High School Diploma or equivalent required, Associate degree or Bachelor’s degree preferred.
Previous experience in healthcare administration, provider enrollment, data processing, customer service, or a related field is preferred.

Responsibilities

Review, validate, and process Medicaid provider enrollment applications in accordance with Rhode Island Medicaid guidelines, ACA requirements, and federal regulations, ensuring compliance with established standards.
Conduct provider screening, maintain accurate provider records, verify enrollment documentation, and safeguard confidential information, including licensing, tax identification, and credentialing data.
Research and resolve enrollment issues, respond to provider inquiries, and collaborate with Gainwell Technologies personnel and State Medicaid liaisons to support enrollment operations.
Develop and maintain reports for tracking, compliance, productivity, and quality monitoring while utilizing enrollment systems and Windows-based applications.
Monitor federal and state policy and regulatory changes, advise leadership on process implications and required actions, and recommend improvements to operational efficiency.