The Provider Enrollment Internal Quality Analyst will export and import data for applicable quality auditing databases and conduct quality assurance audits as assigned within the specified due dates in order to improve daily processing of applications and/or file maintenance transactions.
Responsibilities include:
Conduct targeted audit reviews as assigned within the specified due dates
Conduct specialized audit reviews as assigned within the specified due dates
Review and respond to quality audit disputes within the specified due dates and escalate to leadership as necessary
Respond to escalation requests as assigned within the specified due dates
Ensure data and information are sufficiently accurate and reliable
Perform trending and root cause analysis on quality assurance data to identify training or enhancement needs
Interact professionally with leadership and ancillary staff to provide appropriate and timely response to inquiries and concerns regarding provider enrollment and or file maintenance transactions for the client’s Health Care programs
Make recommendations to management to improve efficiency effectiveness of current manual processes through systemic modifications
Maintain strict confidentiality of information and job files as dictated by current HIPAA requirements
Perform other duties as assigned by leadership