Medicaid Program Integrity Jobs in Rhode Island (NOW HIRING)

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 compliance with Rhode Island Medicaid guidelines, ACA requirements, and federal regulations.
• Maintain and update provider records, conduct enrollment screenings, and ensure documentation is accurate, complete, and compliant.
• Research, analyze, and resolve provider enrollment issues while responding to provider inquiries regarding enrollment status and requirements.
• Collaborate with Gainwell Technologies teams and State Medicaid representatives to support enrollment operations and meet productivity, quality, and compliance standards.
• Utilize enrollment systems and Microsoft Office applications to perform daily responsibilities while identifying opportunities for process improvements and operational efficiencies.

What we're looking for

• Excellent customer service, interpersonal, and computer proficiency skills.
• Strong attention to detail with the ability to accurately manage sensitive provider information.
• Strong analytical and problem-solving skills, including the ability to research, evaluate information, and apply policies and regulations.
• Excellent organizational, time management, and prioritization skills, with the ability to adapt in a fast-paced environment.
• Proficiency with Microsoft Office and Windows-based applications, with the ability to work independently while maintaining confidentiality.

What you should expect in this role

• High school diploma or equivalent required; Associate's or Bachelor's degree preferred.
• Previous experience in healthcare administration, provider enrollment, data processing, customer service, or a related field preferred.
• Ability to read, write, and communicate effectively in English with strong written and verbal communication skills.
• Position is hybrid following training; during the training period, employees are expected to work primarily onsite.
• Schedule is Monday through Friday, 8:30 AM to 5:00 PM. Office location is in Warwick, Rhode Island.

• #LI-Hybrid
• #LI-LS2
• The deadline to submit applications for this posting is 8/1/26.