Provider Credentialing Quality Analyst

Taguig City, Metro Manila
Permanent
Full-time

5 hours ago

Job Description:Provider Credentialing QC Analyst – Role OverviewThe Provider Credentialing QC Analyst is a highly detail-oriented professional responsible for auditing credentialing procedures, ensuring regulatory compliance, and upholding rigorous quality standards. This position requires excellent oral and written communication skills to effectively interact with internal stakeholders and support client-facing quality requirements.Key Responsibilities

Conduct end-to-end quality audits of provider credentialing and re-credentialing files.
Validate provider data across several categories, including:
Licensure, DEA, and CDS certifications
Board certifications
Education and training background
Work history and identification of any gaps
Sanctions from OIG, SAM, and state exclusions
Ensure compliance with NCQA, URAC, and client-specific guidelines
Identify errors, defects, and gaps in processes; deliver actionable feedback to improve quality
Perform root cause analysis (RCA) for quality issues and recommend appropriate corrective actions
Maintain comprehensive audit logs, scorecards, and quality reports on a daily, weekly, and monthly basis
Work collaboratively with operations and training teams to enhance process accuracy
Support internal and external audits, as well as client reviews
Drive initiatives for continuous improvement and implement quality enhancement plans

Quality Metrics Ownership

Maintain an audit accuracy rate of 98%
Control defect leakage within the quality assurance process
Ensure SLA adherence for QC turnaround time
Reduce rework and minimize client escalations

Qualifications:

College degree graduate
Thorough knowledge of the Provider Credentialing lifecycle, including enrollment, revalidation, and ongoing maintenance
Hands-on experience with credentialing portals such as CAQH, NPPES, and PECOS
Deep understanding of U.S. healthcare compliance and regulatory standards
Excellent analytical skills and strong attention to detail
Effective documentation and reporting capabilities
Proficiency in MS Excel, including pivot tables, reports, and trackers
Amenable to work nightshift

Mandatory Skills:

Excellent oral communication skills including ability to clearly articulate quality feedback, audit observations, and process gaps
Confidence in client and stakeholder discussions, as well as review calls
Strong written communication skills including ability to draft professional audit reports, emails, and documentation

Preferred Qualifications:

Experience in payer-side credentialing quality control
Exposure to delegated credentialing audits
Knowledge of health plan requirements
Six Sigma or Lean certification an advantage

Behavioral Expectations:

Demonstrate high ownership and accountability in all responsibilities
Maintain a quality-first mindset throughout all tasks
Adapt and perform effectively in a fast-paced, deadline-driven environment
Apply strong problem-solving skills to resolve issues efficiently

Skills:Healthcare Compliance,Provider Credentialing,U.S. healthcare compliance,NPPES,Quality Audits,CAQH,PECOSAbout Company:UST is a global digital transformation solutions provider. For more than 20 years, UST has worked side by side with the world’s best companies to make a real impact through transformation. Powered by technology, inspired by people and led by purpose, UST partners with their clients from design to operation. With deep domain expertise and a future-proof philosophy, UST embeds innovation and agility into their clients’ organizations. With over 30,000 employees in 30 countries, UST builds for boundless impact—touching billions of lives in the process.

UST

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