QA Credentialing / Provider Enrollment / Quality Audit

We are looking for an experienced Quality Analyst Credentialing with strong knowledge of US Healthcare and provider credentialing processes. The ideal candidate should have hands-on experience in credentialing operations along with quality auditing, process compliance, error identification, and feedback.

Key Responsibilities

• Perform quality audits for Provider Credentialing processes.
• Review credentialing cases for accuracy, completeness, and adherence to defined quality standards.
• Validate provider information and supporting documentation.
• Audit activities related to initial credentialing and re-credentialing.
• Identify process gaps, errors, and recurring quality issues.
• Conduct root-cause analysis and recommend corrective/preventive actions.
• Provide constructive feedback to associates and support quality improvement initiatives.
• Monitor process adherence and ensure compliance with client requirements and internal SOPs.
• Prepare and maintain quality reports, audit findings, and relevant documentation.
• Coordinate with Operations, SMEs, and Training teams to improve process quality.

Required Skills

• Good knowledge of US Healthcare / RCM.
• Strong understanding of Provider Credentialing processes.
• Experience in Quality Auditing / Quality Assurance.
• Knowledge of CAQH and credentialing verification processes is preferred.
• Good analytical and problem-solving skills.
• Strong attention to detail.
• Good verbal and written communication skills.
• Ability to identify errors, analyze trends, and provide effective feedback.

Preferred Candidate Profile

• Relevant experience in US Healthcare Credentialing.
• Prior experience as a Quality Analyst/Quality Auditor in Credentialing preferred.
• Candidates with a combination of credentialing process knowledge and auditing experience will be preferred.

(Immediate joiners preferred)

Job Location: Bengaluru (Embassy Tech Village)

Shift: Night Shift (5:30pm to 2:20am)

Reach out to Sukanya for more info @ 6366384673