Provider Enrollment Specialist Hybrid Warwick, RI

Summary

The 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.

Your role in our mission

• Review, validate, and process Medicaid provider enrollment applications in accordance with Rhode Island Medicaid guidelines, ACA requirements, and federal regulations.

• Conduct provider screening and verify enrollment documentation, licenses, Social Security Numbers, Tax Identification Numbers, and other provider information for accuracy and compliance.

• Maintain and update provider records, research and resolve enrollment-related issues, and respond to provider inquiries regarding enrollment status and requirements.

• Collaborate with Gainwell Technologies personnel and State Medicaid liaisons to resolve issues and meet established productivity, performance, and quality standards.

• Protect confidential information, comply with privacy and regulatory requirements, utilize enrollment systems and Windows-based applications, and recommend process improvements to leadership.

What we're looking for

• Excellent customer service, interpersonal, and computer skills, with proficiency in Microsoft Office and Windows-based systems.

• Strong attention to detail and ability to maintain accuracy and confidentiality when handling sensitive provider information.

• Ability to research and evaluate information, interpret and apply written 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 exercising sound judgment and maintaining confidentiality.

What you should expect in this role

• 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.
• Ability to read, write, and communicate effectively in English.
• Strong written and verbal communication skills.
• Hours: Monday through Friday, 8:30 AM to 5:00 PM
• Work Arrangement: Onsite during training, then hybrid after training (approximately 4 weeks) in Warwick, RI

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"The deadline to submit applications for this posting is November 15, 2026"