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.

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.

Provider Enrollment Quality Analyst

Key skills