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Pe specialist

https://www.randstad.com Logo

Randstad

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Location:
India , Hyderabad

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Category:
Finance

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Contract Type:
Not provided

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Salary:

Not provided
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Job Responsibility:

  • 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
  • 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
  • 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
  • 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
  • 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
  • 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

Requirements:

  • 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

Additional Information:

Job Posted:
December 26, 2025

Expiration:
January 17, 2026

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