SME- Provider enrollment
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Job Location:
Monthly Salary:
Posted on:
2 days ago
Vacancies:
1 Vacancy
Job Summary
Mission of the Role
To function as the senior-most expert in payer enrollment providing deep domain leadership resolving complex escalations driving process improvements and enabling the overall team through knowledge development training and cross-functional collaboration.
Core Responsibilities
1. Domain Leadership & Expertise
Serve as the primary subject matter expert for all payer enrollment processes-Medicare (PECOS) Medicaid (state-specific) and Commercial payers.
Maintain authoritative knowledge of payer rules enrollment requirements credentialing linkages and regulatory changes.
Guide teams on complex enrollment scenarios multi-location/group enrollments tax ID setups and specialty-specific requirements.
2. Process Design & Optimization
Develop document and refine best practices workflows SOPs and quality checklists to improve efficiency and reduce TAT.
Lead continuous improvement initiatives using data trends and root-cause analysis.
Partner with Product/Tech/Automation teams to identify opportunities for digitization and system enhancements.
3. Escalation Management
Act as the point of escalation for the most complex high-impact or time-sensitive enrollment issues.
Troubleshoot payer rejections retro-effective enrollment concerns taxonomy/NPI conflicts CAQH discrepancies and Medicare/Medicaid compliance gaps.
Provide resolution pathways and support Leads/Senior Analysts in executing corrective actions.
4. Training & Capability Building
Build and deliver onboarding and ongoing training modules for Analysts Senior Analysts Leads and Follow-up Specialists.
Conduct periodic knowledge calibrations refresher programs and assessments to ensure consistent process adherence.
Mentor high-potential team members and support leadership in talent development.
5. Stakeholder Collaboration
Work closely with leadership quality teams client services and operational managers to align processes with client expectations.
Collaborate with external payer representatives provider relations teams and regulatory bodies as required.
Support client escalations audits and governance discussions with expert-level insights.
6. Documentation & Governance
Maintain up-to-date knowledge repositories SOPs requirement checklists and payer- specific guidance documents.
Ensure operational compliance with federal/state regulations and client-defined SLAs.
Partner with Quality and Compliance teams to perform audits and highlight systemicgaps.
Required Qualifications
4 6 years of strong experience in Payer Enrollment (Medicare Medicaid Commercial).
Demonstrated expertise in end-to-end enrollment revalidation CAQH NPI/PECOS workflows and payer-specific processes.
Strong analytical skills with the ability to solve high-complexity enrollment blockers.
Excellent communication and stakeholder engagement capabilities.
Experience in training mentoring and guiding operational teams.
Preferred Skills
Exposure to credentialing or provider data management.
Experience working with workflow tools automation systems CRM platforms and payer portals.
Ability to analyze trends and provide insights for operational improvement.
Work Environment & Expectations
Remote Work Allowed but must be flexible to:
Work onsite in Hyderabad for the first 2 months and
Spend a few weeks onsite every quarter thereafter.
Flexible to support escalations or urgent payer interactions as required.
Strong commitment to quality domain accuracy and leadership.
To function as the senior-most expert in payer enrollment providing deep domain leadership resolving complex escalations driving process improvements and enabling the overall team through knowledge development training and cross-functional collaboration.
Core Responsibilities
1. Domain Leadership & Expertise
Serve as the primary subject matter expert for all payer enrollment processes-Medicare (PECOS) Medicaid (state-specific) and Commercial payers.
Maintain authoritative knowledge of payer rules enrollment requirements credentialing linkages and regulatory changes.
Guide teams on complex enrollment scenarios multi-location/group enrollments tax ID setups and specialty-specific requirements.
2. Process Design & Optimization
Develop document and refine best practices workflows SOPs and quality checklists to improve efficiency and reduce TAT.
Lead continuous improvement initiatives using data trends and root-cause analysis.
Partner with Product/Tech/Automation teams to identify opportunities for digitization and system enhancements.
3. Escalation Management
Act as the point of escalation for the most complex high-impact or time-sensitive enrollment issues.
Troubleshoot payer rejections retro-effective enrollment concerns taxonomy/NPI conflicts CAQH discrepancies and Medicare/Medicaid compliance gaps.
Provide resolution pathways and support Leads/Senior Analysts in executing corrective actions.
4. Training & Capability Building
Build and deliver onboarding and ongoing training modules for Analysts Senior Analysts Leads and Follow-up Specialists.
Conduct periodic knowledge calibrations refresher programs and assessments to ensure consistent process adherence.
Mentor high-potential team members and support leadership in talent development.
5. Stakeholder Collaboration
Work closely with leadership quality teams client services and operational managers to align processes with client expectations.
Collaborate with external payer representatives provider relations teams and regulatory bodies as required.
Support client escalations audits and governance discussions with expert-level insights.
6. Documentation & Governance
Maintain up-to-date knowledge repositories SOPs requirement checklists and payer- specific guidance documents.
Ensure operational compliance with federal/state regulations and client-defined SLAs.
Partner with Quality and Compliance teams to perform audits and highlight systemicgaps.
Required Qualifications
4 6 years of strong experience in Payer Enrollment (Medicare Medicaid Commercial).
Demonstrated expertise in end-to-end enrollment revalidation CAQH NPI/PECOS workflows and payer-specific processes.
Strong analytical skills with the ability to solve high-complexity enrollment blockers.
Excellent communication and stakeholder engagement capabilities.
Experience in training mentoring and guiding operational teams.
Preferred Skills
Exposure to credentialing or provider data management.
Experience working with workflow tools automation systems CRM platforms and payer portals.
Ability to analyze trends and provide insights for operational improvement.
Work Environment & Expectations
Remote Work Allowed but must be flexible to:
Work onsite in Hyderabad for the first 2 months and
Spend a few weeks onsite every quarter thereafter.
Flexible to support escalations or urgent payer interactions as required.
Strong commitment to quality domain accuracy and leadership.
