Remote Provider Quality Data Analyst

Navitus Health Solutions, LLC; United States; Remote; USD 54,000 - 65,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Parental leave

Job summary

Navitus Health Solutions, LLC is seeking an Analyst, Provider Quality to support data quality, governance, and regulatory compliance across provider and prescriber data. The role works with Compliance, SIU, IT, and business stakeholders to ensure audit readiness and improve data accuracy across systems.

The position focuses on monitoring data quality, resolving discrepancies, and implementing governance controls while driving process improvements and accurate reporting to support claims and

Qualifications

• Bachelor’s degree or equivalent work experience required.
• 2 years of experience working with provider data and/or validation through healthcare billing, accounts receivable, or credentialing required.
• Experience with data analysis, healthcare claims processing, issue resolution, and process improvement required.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

Responsibilities

• Monitor, validate, and maintain provider and prescriber data to ensure accuracy, completeness, and compliance with regulatory and organizational requirements.
• Ensure proper intake, triage, and prioritization of data quality issues, ensuring timely resolution based on risk, impact, and business needs.
• Investigate and resolve data discrepancies or duplications impacting claims adjudication, system performance, and reporting integrity.
• Assist with the resolution of Prescriber Edits on claims.
• Perform root cause analysis to identify recurring issues and recommend corrective actions to improve data quality and prevent reoccurrence.
• Support validation and reconciliation of internal and external data sources, including vendor-provided data feeds and enrichment files.
• Outreach to prescriber data authorities, including CMS and State Medicaid Programs, to resolve data clarity issues.
• Assist with and resolve issues related to sanction monitoring, defects, state or federal exclusion conflicts or other provider restrictions that may impact claims.
• Escalate complex challenges, overrides, or data conflicts timely and inclusive of actions already taken.
• Prepare and validate documentation to support audit readiness, regulatory inquiries, and client requests, ensuring accuracy and completeness.
• Execute established data governance controls, including data validation checks, exception handling, and adherence to defined processes.
• Maintain and update standard operating procedures (SOPs), work instructions, and supporting documentation related to provider data quality processes.
• Track, analyze, and communicate data quality trends, risks, and performance metrics to inform decision-making and process improvement.
• Other duties as assigned.

Skills

Data analysis

Healthcare claims processing

Issue resolution

Process improvement

Compliance program objectives

Team collaboration

Education

Bachelor’s degree or equivalent

Job description

Navitus Health Solutions, LLC is seeking an Analyst, Provider Quality to support data quality, governance, and regulatory compliance across provider and prescriber data. The role works with Compliance, SIU, IT, and business stakeholders to ensure audit readiness and improve data accuracy across systems.

The position focuses on monitoring data quality, resolving discrepancies, and implementing governance controls while driving process improvements and accurate reporting to support claims and