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.
experience
6show more 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.
experience
6show more
