Analyst, Provider Quality
$54,236–$54,236 year
RemoteNew Jersey, United States or Iowa, United States
Job Summary
Monitor, validate, and maintain provider and prescriber data to ensure accuracy, completeness, and compliance with regulatory requirements. Investigate and resolve data discrepancies impacting claims adjudication, system performance, and reporting integrity. Ensure proper intake, triage, and prioritization of data quality issues based on risk and business needs. Assist with prescriber edits, sanction monitoring, and resolving exclusion conflicts. Perform root cause analysis to recommend corrective actions and support validation of internal and external data sources. Prepare documentation for audit readiness and communicate data quality trends to stakeholders. Work cross-functionally with Compliance, SIU, and IT to manage data-related risks. Maintain standard operating procedures and execute established data governance controls. M-F 8-5pm schedule. Bachelor's degree and two years of healthcare billing or credentialing experience required.
Required Qualifications
- Bachelor's degree or equivalent work experience
- 2 years of experience working with provider data and/or validation through healthcare billing, accounts receivable, or credentialing
- Experience with data analysis, healthcare claims processing, issue resolution, and process improvement
- The ability to consistently interact cooperatively and respectfully with other employees
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