PE Specialist

Hyderabad - India

Monthly Salary: Not Disclosed

Posted on: Yesterday

Vacancies: 1 Vacancy

Job Summary

Key Responsibilities 1. End-to-End Enrollment Management

Manage the full-cycle payer enrollment and revalidation process for healthcare providers (Physicians NPs PAs RNs CRNAs etc.).
Prepare review and submit enrollment applications across Commercial and/or Medicaid payers.
Track application progress follow up with payers and maintain accurate up-to-date documentation.

2. Compliance & Regulatory Adherence

Ensure compliance with federal state and payer-specific policies and guidelines.
Stay updated on changes in payer rules Medicaid regulations CAQH requirements and credentialing standards.
Conduct data quality checks prior to submission to minimize risks of rejections or delays.

3. Issue Resolution & Escalations

Investigate and resolve complex enrollment issues-rejections NPI/taxonomy discrepancies retro-effective enrollment and portal conflicts.
Serve as a point of escalation for difficult payer inquiries.
Coordinate with internal Quality Credentialing and Provider Data teams to address blockers.

4. Process Improvement

Identify inefficiencies in the enrollment workflow and recommend enhancements to reduce turnaround time and improve accuracy.
Support automation and system-improvement initiatives.
Contribute to building standardized templates and best practices.

5. Mentorship & Team Support

Guide and mentor junior Analysts to improve their technical and process knowledge.
Provide feedback through reviews quality checks and coaching discussions.
Participate in team huddles calibrations and performance alignment meetings.

6. Documentation & Reporting

Maintain accurate records within CRM internal workflow tools payer portals and tracking sheets.
Generate periodic reports on submissions status updates pending items and escalations.
Ensure documentation meets audit and compliance expectations.

Required Qualifications

Minimum 2 years of hands-on experience in Payer Enrollment-Commercial or Medicaid depending on the requirement.
Deep understanding of payer portals CAQH NPPES PECOS Medicaid enrollment processes and revalidation cycles.
Proven ability to handle multiple providers and payers simultaneously with high accuracy.
Strong analytical skills to diagnose enrollment issues and execute root-cause corrections.
Clear and professional communication skills both verbal and written.
Ability to work in a high-volume deadline-driven operational environment.

Key Responsibilities 1. End-to-End Enrollment Management Manage the full-cycle payer enrollment and revalidation process for healthcare providers (Physicians NPs PAs RNs CRNAs etc.). Prepare review and submit enrollment applications across Commercial and/or Medicaid payers. Track application prog...