Provider Credentialing Compliance and Quality Analyst

Overview

We are seeking experienced Senior Provider Credentialing Compliance & Quality Analysts to play a vital role in quality oversight, regulatory compliance, and risk mitigation within US healthcare credentialing operations. This position centers on conducting audits, ongoing monitoring, analysis, and implementing corrective actions across credentialing and re-credentialing processes, ensuring adherence to NCQA, CMS, OIG, and state regulatory requirements. The ideal candidate will possess strong analytical skills, exceptional documentation abilities, and effective communication skills. There is also an opportunity to engage with internal stakeholders and support client expectations.

Responsibilities

• Credentialing Quality Oversight: Conduct quality audits and comprehensive file reviews for provider credentialing and re-credentialing activities
• Review credentialing files to ensure accuracy, completeness, and compliance with regulatory ...