Provider Enrollment Quality Analyst

🕒 May 23

🇺🇸 United States – Remote

💵 $43.1k - $61.6k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🚫👨‍🎓 No degree required

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Healthcare Insurance • Human Services • Healthcare

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• support provider enrollment and provider revalidation operations by ensuring the accuracy, quality, and compliance of provider enrollment transactions, documentation, and operational processes. • Conduct quality reviews and audits of provider enrollment applications, provider revalidations, maintenance requests, renewals, and supporting documentation to ensure accuracy, completeness, and compliance with CMS, ACA, state, and federal guidelines. • Monitor operational quality standards, productivity trends, documentation accuracy, and workflow compliance while identifying deficiencies, root causes, and opportunities for process improvement. • Review and evaluate provider-related communications, case documentation, and enrollment activities to ensure adherence to internal policies, operational procedures, and client service expectations. • Prepare reports, analyze quality findings, communicate audit results, and collaborate with leadership to recommend corrective actions, training opportunities, and procedural enhancements. • Support calibration sessions, quality initiatives, audits, training activities, and continuous improvement efforts while maintaining confidentiality and compliance with HIPAA and company security standards.

🎯 Requirements

• High school diploma or GED required; associate degree or additional post-secondary education in healthcare administration, business, or a related field preferred. • 2+ years of experience in provider enrollment, provider revalidation, provider credentialing, healthcare operations, claims processing, healthcare compliance, or quality assurance within a healthcare environment. • Experience performing quality reviews, audits, compliance monitoring, or quality assurance activities in a healthcare operations or production-based environment preferred. • Working knowledge of Medicaid, Medicare, provider enrollment processes, provider data management, healthcare compliance standards, and regulatory guidelines preferred. • Strong analytical, organizational, communication, problem-solving, and Microsoft Office skills, including experience with Excel, reporting tools, and web-based healthcare systems.

🏖️ Benefits

• generous, flexible vacation policy • 401(k) employer match • comprehensive health benefits • educational assistance • leadership and technical development academies