Senior Analyst
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Job Location:
Monthly Salary:
Posted on:
4 hours ago
Vacancies:
1 Vacancy
Job Summary
To drive operational excellence in payer enrollment by managing the complete enrollment lifecycle ensuring regulatory compliance resolving complex enrollment issues and guiding junior team members to meet delivery and quality expectations.
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.
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.
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.
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.
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.
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.
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 Skills
- Splunk
- IDS
- Microsoft Access
- SQL
- Cybersecurity
- Intelligence Experience
- Malware Analysis
- Tableau
- Analysis Skills
- SAS
- Data Analysis Skills
- Analytics
