Provider Enrollment Quality Analyst
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Job Description
Provider Enrollment Quality Analyst supporting Medicaid provider revalidation and fraud prevention initiatives. Ensuring compliance and operational excellence in a fast-paced healthcare environment.
Responsibilities:
- support provider enrollment and provider revalidation operations by ensuring the accuracy, quality, and compliance of provider enrollment transactions, documentation, and operational processes.
- Conduct quality reviews and audits of provider enrollment applications, provider revalidations, maintenance requests, renewals, and supporting documentation to ensure accuracy, completeness, and compliance with CMS, ACA, state, and federal guidelines.
- Monitor operational quality standards, productivity trends, documentation accuracy, and workflow compliance while identifying deficiencies, root causes, and opportunities for process improvement.
- Review and evaluate provider-related communications, case documentation, and enrollment activities to ensure adherence to internal policies, operational procedures, and client service expectations.
- Prepare reports, analyze quality findings, communicate audit results, and collaborate with leadership to recommend corrective actions, training opportunities, and procedural enhancements.
- Support calibration sessions, quality initiatives, audits, training activities, and continuous improvement efforts while maintaining confidentiality and compliance with HIPAA and company security standards.
Requirements:
- High school diploma or GED required; associate degree or additional post-secondary education in healthcare administration, business, or a related field preferred.
- 2+ years of experience in provider enrollment, provider revalidation, provider credentialing, healthcare operations, claims processing, healthcare compliance, or quality assurance within a healthcare environment.
- Experience performing quality reviews, audits, compliance monitoring, or quality assurance activities in a healthcare operations or production-based environment preferred.
- Working knowledge of Medicaid, Medicare, provider enrollment processes, provider data management, healthcare compliance standards, and regulatory guidelines preferred.
- Strong analytical, organizational, communication, problem-solving, and Microsoft Office skills, including experience with Excel, reporting tools, and web-based healthcare systems.
Benefits:
- generous, flexible vacation policy
- 401(k) employer match
- comprehensive health benefits
- educational assistance
- leadership and technical development academies
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