Req ID: RQ185248

Type of Requisition: Regular

Clearance Level Must Be Able to Obtain: None

Public Trust/Other Required: None

Job Family: Healthcare Claims

Skills:

Audit Management,Documentations,Leadership,Medicaid,Provider Enrollment

Experience:

5 + years of related experience

Job Description:

We are GDIT. We take pride in providing our clients with world class customer support. By joining our team in supporting the Federal Civil Division State and Local Health team for a state Medicaid, you will be delivering insights to help our clients make impactful changes real. By owning your opportunity at GDIT, you’ll become a critical part in how we successfully solve our clients’ biggest challenges. GDIT delivers exceptional solutions and services that enable the safety, security, health and well-being of our nation.

As a Provider Enrollment Lead on the GDIT Federal Civil Division State and Local Health team for a state Medicaid program which was awarded in January 2023, you will be supporting the program that will have progressive growth and expansion of services as it is a multi-year program. The program will engage with state customer, subcontracting vendors, and many stakeholder entities. The selected candidate will work managing and maintaining positive relationships between the State of New Mexico Health Care Authority and its network of providers, which can include physicians, hospitals, clinics, Presumptive Eligibility Determiners, and other healthcare facilities.

Role Summary:

As a Provider Enrollment Lead, you will play a key role in leading the provider enrollment team and ensuring the timely and accurate enrollment and credentialing of healthcare providers. You will oversee day-to-day operations, provide guidance to enrollment specialists, and collaborate with internal and external stakeholders to streamline processes and maintain compliance with regulatory requirements.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Team Leadership: Lead a team of Provider Enrollment Specialists, including assigning tasks, providing training and development opportunities, and conducting performance evaluations.

• Enrollment Process Management: Manage the provider enrollment process from initial applications through re-credentialing and updates, ensuring all documentation is complete and accurate.

• Credentialing Oversight: Ensure providers meet credentialing requirements by verifying education, training, licensure, certifications, and other qualifications according to organizational and regulatory standards.

• Compliance Assurance: Monitor and ensure compliance with healthcare regulations, accreditation standards (e.g., NCQA, Joint Commission), throughout the enrollment and credentialing process.

• Relationship Management: Build and maintain relationships with healthcare providers, insurance companies, and internal departments to facilitate effective communication and resolve issues related to enrollment and credentialing.

• Process Improvement: Identify opportunities for process improvements and efficiencies within the provider enrollment function, implementing best practices and standard operating procedures.

• Reporting and Analysis: Generate reports, analyze enrollment data, and track key performance metrics to assess team productivity, identify trends, and provide insights for decision-making.

• Quality Assurance: Develop and implement quality control procedures and standards to ensure accuracy and completeness of provider enrollment documentation.

• Audit and Compliance: Conduct regular audits of enrollment files and processes to verify compliance with healthcare regulations, accreditation standards (e.g., NCQA, Joint Commission), and organizational policies.

What you’ll need to succeed:

Qualifications:

• 5+ years of Medicaid/Medicare Provider Enrollment experience.

• Bachelor’s degree in Healthcare Administration, Business Administration, or a related field (required); Master’s degree preferred.

• Previous experience in provider enrollment, credentialing, or healthcare administration, with demonstrated leadership experience in managing a team.

• Deep understanding of healthcare regulations, accreditation standards, and payer requirements related to provider enrollment and credentialing.

• Strong organizational skills with attention to detail and accuracy in managing documentation and compliance requirements.

• Excellent communication skills, both verbal and written, with the ability to communicate effectively with diverse stakeholders.

• Analytical mindset with the ability to interpret data, identify issues, and propose solutions.

• Proficiency in using enrollment software or databases (e.g., CAQH, NPPES) and MS Office Suite.

Skills:

• Leadership and managerial skills to effectively lead a team and manage complex processes.

• Strategic thinking and problem-solving abilities to address challenges in provider enrollment and credentialing.

• Ability to prioritize tasks, manage multiple projects simultaneously, and meet deadlines.

• Collaboration and interpersonal skills to build relationships and work effectively across departments and with external partners.

• Adaptability and flexibility to navigate changes in healthcare regulations and organizational priorities.

​GDIT IS YOUR PLACE:

• Full-flex work week to own your priorities at work and at home

• 401K with company match

• Comprehensive health and wellness packages

• Internal mobility team dedicated to helping you own your career

• Professional growth opportunities including paid education and certifications

• Cutting-edge technology you can learn from

• Rest and recharge with paid vacation and holidays

The likely salary range for this position is $68,000 - $92,000. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.

Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employee’s date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.

We are GDIT. A global technology and professional services company that delivers consulting, technology and mission services to every major agency across the U.S. government, defense and intelligence community. Our 30,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 30 countries worldwide, offering leading capabilities in digital modernization, AI/ML, Cloud, Cyber and application development. Together with our clients, we strive to create a safer, smarter world by harnessing the power of deep expertise and advanced technology.

We connect people with the most impactful client missions, creating an unparalleled work experience that allows them to see their impact every day. We create opportunities for our people to lead and learn simultaneously. From securing our nation’s most sensitive systems, to enabling digital transformation and cloud adoption, our people are the ones who make change real.

GDIT is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status, or any other protected class.