SME - Payer Enrollment

Iopex; Chennai District; On-site; INR 1,200,000 - 1,800,000; Full time

Job summary

Iopex is seeking a knowledgeable SME for Payer Enrollment to lead provider enrollment efforts in Chennai. The role focuses on payor-specific requirements, documentation quality, and regulatory compliance.

The candidate will guide teams, handle escalations, and drive process optimization across Medicare, Medicaid and commercial payors while staying updated on CMS and related portals.

Qualifications

• 4–6 years of US provider enrollment experience.
• Deep understanding of Medicare, Medicaid and commercial payor processes.

Responsibilities

• Serve as the SME for all provider enrollment processes and payor requirements.
• Support teams with complex enrollment cases and documentation issues.
• Review and guide high-quality enrollment applications for Medicare, Medicaid and commercial payors.
• Conduct root-cause analysis for rejections and denials; propose corrective actions.
• Train teams on payor policies, enrollment workflows and updated regulations.
• Maintain knowledge of CMS, NPPES, PECOS, CAQH and state enrollment requirements.
• Collaborate with credentialing, operations and quality teams to ensure seamless workflows.
• Monitor process performance and share improvement insights.
• Prepare SOPs, checklists and reference materials for the enrollment team.
• Assist leadership with audits, reporting and special projects.

Skills

US provider enrollment

Medicare enrollment

NPPES Knowledge

PECOS

CAQH

MS Office

Root-cause analysis

Training/knowledge transfer

Stakeholder communication

Tools

PECOS

NPPES

CAQH

Medicaid portals

Commercial payor portals

Job description

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.