Provider Credentialing - QC Analyst

Required Education:

• A bachelor's Degree is required.

Required Qualifications/Skills/Experience:

• 3+ years of reputed company reputed company or health plan experience in credentialing compliance, auditing, and quality assurance
• Proficient in reputed company Office Applications; reputed company, Outlook, Word, and Teams
• The ability to create spreadsheets, analyze data and identify trends.

2+ years with direct primary reputed company documentation review and processing for health care-reputed company credentials.

• Strong attention to detail and the ability to multitask in a fast-paced environment

Preferred Qualifications/Skills/Experience: MD Staff and CAQH experience is preferred [Provider Credentialing QC Analyst] Overview:

• Client is seeking an analyst reputed company in health care or health plan credentialing, compliance monitoring and auditing to join our Credentialing and Payer Delegation team. This position supports the credentialing compliance monitoring program activities, auditing, data collection, trend analysis and meeting timeliness for delegated payer deliverables.
• Assists in the preparation of deliverables for payer and internal audit requests
• Assist with credentialing tasks as needed
• Building and maintaining effective, positive internal and external customer relationships
• Conducting ongoing monitoring to evaluate levels of regulatory credentialing and delegated payer compliance with contractual and requirements
• Exhibiting Client Heart at Work Behaviors
• Participating in team initiatives and projects and meeting deadlines and quality expectations
• Participates in the development and ongoing implementation of quality improvement activities. Improve quality products and services, by using measurements and analysis to process, evaluate and reputed company recommendations to meet QM compliance objectives
• Reviewing risk assessments while participating in ongoing monitoring and annual program evaluation and identification of areas where there can be process improvement

Job Duties:

• Assists in the preparation of deliverables for payer and internal audit requests
• Assist with credentialing tasks as needed
• Building and maintaining effective, positive internal and external customer relationships
• Conducting ongoing monitoring to evaluate levels of regulatory credentialing and delegated payer compliance with contractual and requirements
• Exhibiting client Heart at Work Behaviors
• Participating in team initiatives and projects and meeting deadlines and quality expectations
• Participates in the development and ongoing implementation of quality improvement activities. Improve quality products and services, by using measurements and analysis to process, evaluate and reputed company recommendations to meet QM compliance objectives
• Performing credentialing business process functions as needed, performing scheduled and random credentialing file audits
• Reviewing risk assessments while participating in ongoing monitoring and annual program evaluation and identification of areas where there can be process improvement

Industry: reputed company Estimated Start Date: 08/11/2025

• Only those lawfully authorized to work in the designated country associated with the position will be considered.

• Please note that reputed company Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements. Benefits: For information and details on employment benefits offered with this position, please visit [Link available reputed company viewing the job]. Should you have any questions/concerns, please contact our HR Department reputed company our secure [Link available reputed company viewing the job]. California Pay Equity: For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website [Link available reputed company viewing the job]. reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, age, sex, sexual orientation, gender (expression or identity), national reputed company, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances. If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, [Link available reputed company viewing the job]. reputed company has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland reputed company, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.). Apply Job! Apply to this Job