Quality Analyst – US Healthcare Credentialing & Provider Enrollment

Confidential Hires; India; Remote; INR 5,698,000 - 8,547,000; Full time

Job summary

Confidential Hires is seeking a Quality Analyst for Credentialing & Enrollment to ensure accuracy, compliance, and efficiency across processes. The role requires experience with Medicare, Medicaid, and commercial payers, and proficiency with CAQH, PECOS, NPPES, and payer portals.

This remote, full-time position supports US healthcare operations and emphasizes quality control and continuous improvement. The ideal candidate will have 5+ years of hands-on US credentialing experience, excellent

Qualifications

• Minimum 5 years of hands-on experience in US healthcare credentialing and provider enrollment.
• Strong knowledge of Medicare, Medicaid, and commercial payer enrollment processes.
• Experience with CAQH, PECOS, NPPES, and payer portals.
• Detail-oriented with ability to identify discrepancies before submission.
• Proficient in Excel, Word, and standard reporting tools.

Responsibilities

• Perform quality audits of credentialing and enrollment applications before submission.
• Review applications for completeness, accuracy, and payer compliance.
• Verify demographics, licenses, NPI details, taxonomy codes, locations, and documentation.
• Identify errors and compliance risks and communicate findings.
• Maintain quality scorecards and corrective-action trackers.
• Provide actionable feedback and drive process improvements.
• Escalate critical errors to management.
• Support SOP updates and training materials.
• Track KPIs and prepare quality reports.

Skills

Attention to detail

Analytical skills

Problem-solving

Communication skills

Tools

CAQH

PECOS

NPPES

Payer portals

Microsoft Excel

Microsoft Word

Job description

We're Hiring: Quality Analyst – Credentialing & Provider Enrollment

Job Type: Full-Time

Work Mode: Remote / Work From Home

Experience Required: Minimum 5 Years

Working Hours: 9:00 AM – 6:00 PM EST, Monday–Friday

A US Healthcare company provides healthcare credentialing, provider enrollment, revenue cycle management, and related operational support services to healthcare providers and medical practices across the United States.

We are looking for an experienced and detail-oriented Quality Analyst – Credentialing & Provider Enrollment to ensure accuracy, compliance, consistency, and operational excellence across our credentialing and enrollment processes.

The ideal candidate will have at least five years of hands-on experience in US healthcare credentialing and provider enrollment, with a strong understanding of payer requirements, application submission workflows, quality audits, and error prevention.

Key Responsibilities

1. Quality Audits & Process Reviews

• Conduct quality audits of provider credentialing and enrollment applications before submission and at relevant stages of processing.
• Review applications for completeness, accuracy, consistency, and compliance with payer-specific requirements.
• Audit provider demographics, licenses, certifications, NPI details, taxonomy codes, practice locations, ownership information, and supporting documentation.
• Identify errors, omissions, discrepancies, and potential compliance risks before they affect submissions or client accounts.
• Ensure applications and supporting documents meet internal quality standards and applicable payer requirements.

2. Credentialing & Provider Enrollment Quality Control

• Review applications and enrollment activities related to Medicare, Medicaid, and commercial insurance payers.
• Validate information entered into CAQH, PECOS, NPPES, and applicable payer portals.
• Verify the accuracy of provider and group enrollment information, re-credentialing submissions, demographic updates, and other enrollment-related transactions.
• Review payer follow-ups, application status updates, approval documentation, and effective-date information for accuracy.
• Ensure quality standards are consistently followed throughout the onboarding and application filing processes.
• Document audit findings and communicate errors to the responsible onboarding specialists and application filers.
• Provide clear, actionable feedback and coordinate corrective actions to prevent recurring errors.
• Identify root causes of quality issues and recommend improvements to workflows, checklists, and standard operating procedures (SOPs).
• Escalate critical errors, recurring quality concerns, and potential compliance issues to management.

4. Quality Reporting & Performance Monitoring

• Maintain accurate audit records, quality scorecards, error logs, and corrective-action trackers.
• Prepare daily, weekly, and monthly quality reports for management.
• Track quality metrics, including audit scores, error rates, application accuracy, rework, and recurring deficiencies.
• Analyze trends and recommend practical measures to improve team performance and reduce avoidable rework.
• Work with operations leadership to improve credentialing and provider enrollment processes.
• Provide coaching and process feedback to team members based on audit results.
• Assist in updating quality checklists, SOPs, and internal training materials.
• Support the implementation of standardized quality controls across onboarding and application filing teams.

Required Qualifications & Experience

• Minimum 5 years of hands-on experience in US healthcare credentialing and provider enrollment.
• Strong knowledge of Medicare, Medicaid, and commercial payer enrollment processes.
• Practical experience with CAQH, PECOS, NPPES, and payer-specific portals.
• Proven experience conducting quality audits, reviewing applications, identifying errors, and documenting findings.
• Strong understanding of provider demographics, NPI Type 1 and Type 2, taxonomy codes, licensing, certifications, practice locations, and enrollment documentation.
• Excellent attention to detail and the ability to identify discrepancies before application submission.
• Strong analytical, documentation, communication, and problem-solving skills.
• Proficiency in Microsoft Excel, Word, and other standard reporting tools.
• Ability to work independently, manage audit workloads, and meet deadlines in a remote work environment.

Work-From-Home Requirements

Candidates must meet the following technical and work-environment requirements:

• Must have their own Windows 11 laptop or computer suitable for professional work.
• Must have a reliable internet connection with a minimum speed of 100 Mbps.
• Must have a stable work-from-home setup with minimal background noise and interruptions.
• Must be comfortable working with online portals, cloud-based systems, spreadsheets, and remote communication tools.
• Must maintain the confidentiality and security of provider information and company data.
• Must be available to work 9:00 AM to 6:00 PM Eastern Standard Time (EST), Monday through Friday.

Please note: The working hours follow US Eastern Time and may shift by one hour during daylight saving time, depending on the company's scheduling policy.

Key Performance Indicators (KPIs)

Performance will be evaluated based on:

• Accuracy and consistency of quality audits.
• Timely completion of assigned audits.
• Identification and prevention of application errors.
• Reduction in repeat errors and avoidable rework.
• Quality of audit documentation and reporting.
• Effectiveness of corrective feedback and process improvement recommendations.
• Adherence to internal SOPs, confidentiality standards, and quality requirements.

What We Offer

• A full-time remote working opportunity.
• The opportunity to contribute to the quality and efficiency of US healthcare operations.
• A professional environment focused on accountability, process improvement, and operational excellence.
• The opportunity to work closely with credentialing, provider enrollment, and operations leadership.