Job Summary
The Provider Enrollment Services (PES) Quality Analyst is responsible for monitoring, auditing, and
improving the quality and accuracy of provider enrollment processes across multiple payors and clients.
The role focuses on ensuring compliance with client guidelines, reducing errors, improving turnaround
time, and driving continuous process improvement through detailed quality reviews and feedback
sessions.
The analyst will work closely with Operations, Training, and Leadership teams to maintain high-quality
standards and support operational excellence.
Key Responsibilities
Quality Audits & Compliance
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Conduct quality audits for provider enrollment and credentialing cases.
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Review enrollments for accuracy, completeness, and compliance with client and payor
requirements.
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Ensure adherence to SOPs, workflows, turnaround time (TAT), and quality benchmarks.
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Identify documentation gaps, submission errors, and process deviations.
Error Analysis & Reporting
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Track and categorize quality errors and trends.
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Prepare daily, weekly, and monthly quality reports.
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Maintain audit scorecards and quality dashboards.
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Perform root cause analysis (RCA) for recurring issues.
Feedback & Coaching
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Provide timely and constructive feedback to operations teams.
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Conduct calibration sessions with operations and training teams.
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Support refresher training initiatives based on audit findings.
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Assist in improving employee performance through coaching recommendations.
Process Improvement
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Identify opportunities for process optimization and automation.
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Recommend updates to SOPs, audit templates, and quality guidelines.
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Participate in client calls and internal quality discussions when required.
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Collaborate with stakeholders to improve accuracy and operational efficiency.
Documentation & Governance
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Maintain audit documentation and quality records.
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Ensure data integrity and reporting accuracy.
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Support internal and external audits as needed.
Internal Hiring Eligibility
Candidates applying internally should:
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Meet minimum performance expectations.
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Have no active disciplinary actions.
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Demonstrate strong process knowledge and communication skills.
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Show interest in quality management and process improvement.
Required Qualifications
Education
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Bachelor’s degree preferred.
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Equivalent work experience in healthcare operations may be considered.
Experience
- 2–5 years of experience in:
o Provider Enrollment Services (PES)
o Credentialing
o Quality Assurance / Auditing
Preferred Experience
- Experience working with:
o CAQH
o PECOS
o NPPES
o Commercial and Government Payors
Required Skills
Technical Skills
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Strong understanding of provider enrollment workflows.
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Knowledge of healthcare payors and credentialing requirements.
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Proficiency in:
o Microsoft Excel
o PowerPoint
o Reporting dashboards
o Audit tracking tools
Analytical Skills
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Strong attention to detail.
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Ability to identify trends and process gaps.
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Good problem-solving and analytical thinking abilities.
Communication Skills
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Strong verbal and written communication.
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Ability to provide professional feedback and coaching.
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Good stakeholder management skills.
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