Quality Analyst - Payer Enrollment

Iopex; Chennai District; Vor Ort; INR 550.000 - 850.000; Vollzeit

Zusammenfassung

Iopex is seeking a Quality Analyst Provider Enrollment to ensure accuracy and compliance in provider data management and credentialing. You will audit enrollment files, validate data in systems like NPPES/PECOS, and drive process improvements.

Ideal candidates will have 4–8 years in provider enrollment or related fields, with QA experience in healthcare operations and strong attention to detail. Collaboration with training and operations teams is essential, along with supporting audits for

Qualifikationen

• Bachelor's degree preferred in healthcare-related field.
• 4–8 years in provider enrollment, credentialing, or provider data management.
• 2+ years in quality auditing or QA within healthcare operations preferred.
• Familiar with payer enrollment processes and provider data elements (NPI, taxonomy, etc.).
• Knowledge of CMS, CAQH, HIPAA regulations.

Aufgaben

• Conduct quality audits on provider enrollment files and transactions to ensure compliance with payer, state, and organizational requirements.
• Validate provider data accuracy in systems (e.g., NPPES, CAQH, PECOS, payer portals).
• Review new enrollments, revalidations, terminations, and demographic updates for correctness and adherence to SOPs.
• Identify quality issues, root causes, and recurring trends; recommend corrective actions and process improvements.
• Maintain audit logs, prepare quality reports, and track performance metrics (accuracy %, rework %, compliance errors, etc.).
• Collaborate with the Training and Operations teams to address knowledge gaps and provide targeted feedback to staff.
• Support internal and external audits by ensuring documentation readiness and adherence to compliance standards (HIPAA, CMS, NCQA, etc.).
• Participate in calibration sessions to ensure alignment in audit scoring and quality standards.
• Assist in developing and updating audit checklists, SOPs, and training materials.
• Contribute to continuous improvement initiatives focused on accuracy, efficiency, and provider satisfaction.

Kenntnisse

Attention to detail

Analytical skills

Communication skills

Data interpretation

Ausbildung

Bachelor's degree in Healthcare Administration / Life Sciences

Tools

MS Excel

Audit tracking tools

CRM / PECOS

Jobbeschreibung

Job Summary:

The Quality Analyst Provider Enrollment is responsible for ensuring the accuracy, compliance, and completeness of all provider enrollment activities. This role involves reviewing completed transactions, identifying process gaps, providing feedback, and driving continuous improvement to maintain high-quality standards in provider data management and credentialing functions.

Key Responsibilities:

• Conduct quality audits on provider enrollment files and transactions to ensure compliance with payer, state, and organizational requirements.
• Validate provider data accuracy in systems (e.g., NPPES, CAQH, PECOS, payer portals).
• Review new enrollments, revalidations, terminations, and demographic updates for correctness and adherence to SOPs.
• Identify quality issues, root causes, and recurring trends; recommend corrective actions and process improvements.
• Maintain audit logs, prepare quality reports, and track performance metrics (accuracy %, rework %, compliance errors, etc.).
• Collaborate with the Training and Operations teams to address knowledge gaps and provide targeted feedback to staff.
• Support internal and external audits by ensuring documentation readiness and adherence to compliance standards (HIPAA, CMS, NCQA, etc.).
• Participate in calibration sessions to ensure alignment in audit scoring and quality standards.
• Assist in developing and updating audit checklists, SOPs, and training materials.
• Contribute to continuous improvement initiatives focused on accuracy, efficiency, and provider satisfaction.

Required Qualifications:

• Bachelor’s degree preferred (Healthcare Administration, Life Sciences, or related field).
• Minimum 4– 8 years of experience in provider enrollment, credentialing, or provider data management.
• Minimum 2 year of experience in quality auditing or quality assurance within healthcare operations preferred.
• Payer enrollment processes (Medicare, Medicaid, Commercial payers).
• Healthcare provider data elements (NPI, taxonomy, specialties, licensure, etc.).
• Regulatory guidelines and industry standards (CMS, CAQH, HIPAA).

Technical Skills:

• Proficiency in MS Excel and audit tracking tools.
• Experience with provider data systems, CRMs, or workflow tools (e.g., Salesforce, PECOS, or internal platforms).

Key Competencies:

• Strong attention to detail and analytical skills.
• Excellent written and verbal communication.
• Ability to interpret data and identify process trends.
• Good organizational and time management skills.
• Collaborative mindset with the ability to work cross-functionally.
• Commitment to maintaining data integrity and confidentiality.