Provider Enrollment Quality Analyst - Jackson, MS (Onsite)

Gainwell Technologies LLC•Jackson, MS

21h•$47,100 - $67,300•Onsite

About The Position

As a Provider Enrollment Quality Analyst at Gainwell, you will contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve. This role performs detailed quality reviews, audits enrollment transactions, and identifies process improvement opportunities to ensure adherence to regulatory, contractual, and organizational requirements. The analyst serves as a subject matter expert in provider enrollment processes and supports continuous improvement initiatives to enhance operational performance and provider experience.

Requirements

Associates degree in Healthcare Administration, Business Administration, or related field preferred; equivalent experience may be considered.
2 or more years of experience in provider enrollment, credentialing, provider data management, healthcare operations, quality assurance, auditing, or compliance-related functions preferred.
Experience working with Medicaid, Medicare, managed care organizations, or healthcare payers preferred.
Advanced analytical, problem-solving, and organizational skills.
Proficiency with Microsoft Office Suite, reporting tools, and provider management systems.
Strong written and verbal communication skills.

Responsibilities

Conduct quality audits of provider enrollment, recredentialing, demographic maintenance, and provider data management transactions.
Review enrollment documentation for completeness, accuracy, and compliance with state, federal, client, and organizational requirements.
Monitor adherence to service level agreements (SLAs), quality standards, and operational procedures.
Identify trends, defects, and process gaps, and provide actionable recommendations for improvement.
Perform root cause analysis on quality issues and partner with leadership to implement corrective actions.
Prepare and distribute audit findings to leadership.
Track and trend audit results to identify refresher training, as needed.
Assist in developing quality assurance methodologies, audit tools, and monitoring processes.
Collaborate with Provider Enrollment Specialists, Credentialing teams, Operations leadership, and Compliance partners to improve overall quality performance.
Support internal audits by providing documentation, reports, and quality metrics.
Participate in training initiatives and provide coaching based on audit findings and performance trends.
Maintain expertise in provider enrollment regulations, credentialing requirements, payer guidelines, CMS requirements, and state-specific policies.