Provider Credentialing - QC Analyst

Required Education:

• A bachelor's Degree is required.

Required Qualifications/Skills/Experience:

• 3+ years of related healthcare or health plan experience in credentialing compliance, auditing, and quality assurance
• Proficient in Microsoft Office Applications; Excel, Outlook, Word, and Teams
• The ability to create spreadsheets, analyze data and identify trends.

2+ years with direct primary source documentation review and processing for health care-related credentials.

• Strong attention to detail and the ability to multitask in a fast-paced environment

Preferred Qualifications/Skills/Experience: MD Staff and CAQH experience is preferred [Provider Credentialing QC Analyst] Overview:

• Client is seeking an analyst experienced in health care or health plan credentialing, compliance monitoring and auditing to join our Credentialing and Payer Delegation team. This position supports the credentialing compliance monitoring program activities, auditing, data collection, trend analysis and meeting timeliness for delegated payer deliverables.
• Assists in the preparation of deliverables for payer and internal audit requests
• Assist with credentialing tasks as needed
• Building and maintaining effective, positive internal and external customer relationships
• Conducting ongoing monitoring to evaluate levels of regulatory credentialing and delegated payer compliance with contractual and requirements
• Exhibiting Client Heart at Work Behaviors
• Participating in team initiatives and projects and meeting deadlines and quality expectations
• Participates in the development and ongoing implementation of quality improvement activities. Improve quality products and services, by using measurements and analysis to process, evaluate and make recommendations to meet QM compliance objectives
• Reviewing risk assessments while participating in ongoing monitoring and annual program evaluation and identification of areas where there can be process improvement

Job Duties:

• Assists in the preparation of deliverables for payer and internal audit requests
• Assist with credentialing tasks as needed
• Building and maintaining effective, positive internal and external customer relationships
• Conducting ongoing monitoring to evaluate levels of regulatory credentialing and delegated payer compliance with contractual and requirements
• Exhibiting client Heart at Work Behaviors
• Participating in team initiatives and projects and meeting deadlines and quality expectations
• Participates in the development and ongoing implementation of quality improvement activities. Improve quality products and services, by using measurements and analysis to process, evaluate and make recommendations to meet QM compliance objectives
• Performing credentialing business process functions as needed, performing scheduled and random credentialing file audits
• Reviewing risk assessments while participating in ongoing monitoring and annual program evaluation and identification of areas where there can be process improvement

Industry: Healthcare Estimated Start Date: 08/11/2025

• Only those lawfully authorized to work in the designated country associated with the position will be considered.

• Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements. Benefits: For information and details on employment benefits offered with this position, please visit [Link available when viewing the job]. Should you have any questions/concerns, please contact our HR Department via our secure [Link available when viewing the job]. California Pay Equity: For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website [Link available when viewing the job]. Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances. If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, [Link available when viewing the job]. Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.). Apply Job! Apply to this Job