Senior Provider Enrollment Specialist Hybrid Warwick, RI

About the role

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. 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.

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.

Qualifications

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.

Skills

• 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.

Benefits

Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a