Role Title: Senior Analyst – Payer EnrollmentDepartment: ProviderOperationLocation: Hyderabad – Work From Office (WFO only)
Mission of the Role
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.
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.).
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● 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.
experience
5
