pe specialist.

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.
   

• 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.
   

experience