4 - 7 Years
- 1 Opening
- Chennai

Role description:
Job Title: Provider Credentialing Quality Analyst (QC)

Shift: US Shift (5:30 PM - 2:30 AM IST)

Experience: 4-8 Years in US Healthcare Credentialing (Minimum 2+ Years in QC/Audit Role)

Role Summary : We are looking for a highly detail-oriented Provider Credentialing QC Analyst responsible for auditing credentialing processes, ensuring compliance, and maintaining high-quality standards. This role demands excellent communication skills (both oral and written) to interact with internal stakeholders and support client-facing quality expectations.

Key Responsibilities:
- Perform end-to-end quality audits of provider credentialing and re-credentialing files
- Validate provider data including:
- Licensure, DEA, CDS
- Board certifications
- Education & training
- Work history and gaps
- Sanctions (OIG, SAM, State exclusions)
- Ensure compliance with:
- NCQA, URAC, and client-specific guidelines
- Identify errors, defects, and process gaps; provide actionable feedback
- Conduct root cause analysis (RCA)



for quality issues and recommend corrective actions
- Maintain audit logs, scorecards, and quality reports (daily/weekly/monthly)
- Collaborate with operations/training teams to improve process accuracy
- Support internal/external audits and client reviews
- Drive continuous improvement initiatives and quality enhancement plans

Quality Metrics Ownership:
- Audit accuracy 98%
- Defect leakage control
- SLA adherence for QC turnaround time
- Reduction in rework and client escalations

Required Skills & Competencies:
- Strong knowledge of Provider Credentialing lifecycle (Enrollment, Revalidation, Maintenance)
- Hands-on experience with:
- CAQH, NPPES, PECOS portals
- Deep understanding of:
- US healthcare compliance and regulatory standards
- Excellent analytical and attention-to-detail skills
- Robust documentation and reporting ability
- Proficiency in MS Excel (pivot, reports, trackers)
- Effective communication and st

📌 Associate Iii (Chennai)
🏢 UST Global
📍 Chennai