Job Type: Full-Time, Contract (6 Months)
Location: Fully Remote – Anywhere in the U.S. (Never onsite required)
Work Hours: Monday – Friday, 8:30 AM – 5:00 PM EST
Position Summary:
We are seeking an Analyst I – Provider Credentialing (QC Analyst) to support the Credentialing and Payer Delegation team. This role focuses on credentialing compliance monitoring, auditing, data collection, trend analysis, and payer deliverables. The analyst will also assist with audit preparation, credentialing tasks, and ongoing monitoring activities to ensure regulatory compliance with credentialing and payer requirements.
This position requires strong analytical skills, advanced Excel knowledge, and the ability to work independently in a remote environment while managing multiple priorities and deadlines.
Key Responsibilities:
- Assist in preparing deliverables for payer and internal audit requests.
- Perform credentialing business process functions, scheduled/random audits, and compliance monitoring.
- Review risk assessments and participate in annual program evaluations to identify areas for process improvement.
- Support credentialing compliance monitoring program activities, including data collection and trend analysis.
- Ensure timeliness and accuracy for delegated payer deliverables.
- Collaborate with internal/external teams to build and maintain effective relationships.
- Contribute to quality improvement activities using measurement and analysis to evaluate compliance objectives.
- Communicate professionally and respectfully in all interactions while exhibiting CVS Health’s Heart at Work behaviors.
- 3+ years of healthcare or health plan experience in credentialing compliance, auditing, or quality assurance.
- Proficiency in Microsoft Excel (must be able to perform VLOOKUPs, filtering, formulas, and manual data entry).
- Strong knowledge of Microsoft Office applications (Excel, Outlook, Word, Teams).
- Ability to analyze data, identify trends, and provide insights.
- Strong attention to detail and organizational skills.
- Ability to manage time effectively and work independently in a remote environment.
- Must have a quiet home office setup and reliable internet connection.
- MDStaff system experience (preferred, not required).
- Familiarity with NCQA compliance requirements.
- Prior experience in quality assurance or process improvement initiatives.
Bachelor’s Degree (Required)
