SME - Payer Enrollment

Job Title: SME Payer Enrollment

Work Mode: Work From Office (WFO)

Location: Chennai

Job Summary

We are seeking a knowledgeable and detail-driven Subject Matter Expert (SME) – Payer Enrollment to support complex provider enrollment functions. The SME will act as the go-to expert for payor enrollment processes, regulations, documentation, and best practices. This role will guide teams, support escalations, ensure compliance, and contribute to process optimization.

Key Responsibilities

• Serve as the primary subject matter expert for all provider enrollment processes, guidelines, and payor-specific requirements.
• Support teams by providing solutions for complex enrollment cases, escalations, and documentation issues.
• Review, validate, and guide the preparation of high-quality enrollment applications for Medicare, Medicaid, and commercial payors.
• Conduct root-cause analysis for rejections, denials, and repeated errors; propose corrective actions.
• Train new and existing team members on payor policies, enrollment workflows, and updated regulations.
• Maintain updated knowledge of CMS, NPPES, PECOS, CAQH, and state-specific enrollment requirements.
• Collaborate with internal teams such as credentialing, operations, and quality to ensure seamless workflows.
• Monitor process performance and share insights on improvements and standardization.
• Prepare and maintain SOPs, checklists, and reference materials for the provider enrollment team.
• Assist leadership with audits, reporting, and special projects related to provider onboarding and data management.

Required Qualifications & Skills

• 4–6 years of experience in US provider enrollment, with deep understanding of Medicare, Medicaid, and commercial payor processes.
• Expertise with enrollment platforms such as PECOS, NPPES, CAQH, Medicaid portals, and commercial payor portals.
• Strong understanding of provider types, taxonomy codes, NPI setups, revalidations, and reassignment workflows.
• Excellent problem-solving skills and ability to explain complex concepts clearly.
• Strong communication, documentation, and stakeholder-facing abilities.
• Proficient in MS Office and enrollment tracking systems.
• Ability to support teams, manage escalations, and handle high-volume tasks efficiently.