Professional, Quality Analysis (PES)

Job Summary

The Provider Enrollment Services (PES) Quality Analyst is responsible for monitoring, auditing, and

improving the quality and accuracy of provider enrollment processes across multiple payors and clients.

The role focuses on ensuring compliance with client guidelines, reducing errors, improving turnaround

time, and driving continuous process improvement through detailed quality reviews and feedback

sessions.

The analyst will work closely with Operations, Training, and Leadership teams to maintain high-quality

standards and support operational excellence.

Key Responsibilities

Quality Audits & Compliance

Conduct quality audits for provider enrollment and credentialing cases.

Review enrollments for accuracy, completeness, and compliance with client and payor

requirements.

Ensure adherence to SOPs, workflows, turnaround time (TAT), and quality benchmarks.

Identify documentation gaps, submission errors, and process deviations.

Error Analysis & Reporting

Track and categorize quality errors and trends.

Prepare daily, weekly, and monthly quality reports.

Maintain audit scorecards and quality dashboards.

Perform root cause analysis (RCA) for recurring issues.

Feedback & Coaching

Provide timely and constructive feedback to operations teams.

Conduct calibration sessions with operations and training teams.

Support refresher training initiatives based on audit findings.

Assist in improving employee performance through coaching recommendations.

Process Improvement

Identify opportunities for process optimization and automation.

Recommend updates to SOPs, audit templates, and quality guidelines.

Participate in client calls and internal quality discussions when required.

Collaborate with stakeholders to improve accuracy and operational efficiency.

Documentation & Governance

Maintain audit documentation and quality records.

Ensure data integrity and reporting accuracy.

Support internal and external audits as needed.

Internal Hiring Eligibility

Candidates applying internally should:

Meet minimum performance expectations.

Have no active disciplinary actions.

Demonstrate strong process knowledge and communication skills.

Show interest in quality management and process improvement.

Required Qualifications

Education

Bachelor’s degree preferred.

Equivalent work experience in healthcare operations may be considered.

Experience

2–5 years of experience in:

o Provider Enrollment Services (PES)

o Credentialing

o Quality Assurance / Auditing

Preferred Experience

Experience working with:

o CAQH

o PECOS

o NPPES

o Commercial and Government Payors

Required Skills

Technical Skills

Strong understanding of provider enrollment workflows.

Knowledge of healthcare payors and credentialing requirements.

Proficiency in:

o Microsoft Excel

o PowerPoint

o Reporting dashboards

o Audit tracking tools

Analytical Skills

Strong attention to detail.

Ability to identify trends and process gaps.

Good problem-solving and analytical thinking abilities.

Communication Skills

Strong verbal and written communication.

Ability to provide professional feedback and coaching.

Good stakeholder management skills.