Location/Onsite: Fully Remote (Work from Home – Anywhere in the U.S.)
Schedule: Monday – Friday, 8:30 AM – 5:00 PM EST
Contract Duration: 6 Months, 40 Hours per/week
Department: Provider Credentialing
Position Summary
We are seeking an Analyst I – Provider Credentialing (QC Analyst) to join the Credentialing and Payer Delegation team. This position supports the credentialing compliance monitoring program through auditing, data collection, trend analysis, and timely reporting for delegated payer deliverables .
The Analyst ensures that credentialing activities meet contractual and regulatory requirements while maintaining compliance with internal quality standards. This role requires strong attention to detail, excellent data management skills, and the ability to work independently in a fully remote environment aligned with Eastern Standard Time (EST) business hours.
Duties & Responsibilities
- Assist in the preparation of payer and internal audit deliverables.
- Perform credentialing business process functions as needed, including scheduled and random file audits.
- Conduct ongoing monitoring to evaluate compliance with regulatory and delegated payer requirements.
- Participate in the development and implementation of quality improvement activities to meet QM and compliance objectives.
- Review risk assessments and contribute to process improvement and annual program evaluation.
- Maintain detailed and accurate documentation of audit findings and credentialing records.
- Collaborate effectively with internal and external teams to maintain positive working relationships.
- Communicate professionally and respectfully in all forms of interaction.
- Work independently to meet tight deadlines while maintaining a high level of accuracy and quality.
- Exhibit CVS Health’s Heart at Work Behaviors, contributing to a positive, collaborative team culture.
Required Skills & Experience
- 3+ years of related healthcare or health plan experience in credentialing compliance, auditing, and quality assurance.
- Strong proficiency in Microsoft Excel (must be able to perform VLOOKUPs, filter data, create formulas manually, and add comments).
- Proficient in Microsoft Office applications including Excel, Outlook, Word, and Teams.
- Skilled in data entry, review, and analysis to identify patterns, discrepancies, and trends.
- Strong attention to detail with excellent organizational and time management skills.
- Ability to multi-task effectively in a fast-paced, high-volume environment.
- Comfortable working independently in a remote setting with minimal supervision.
- Demonstrated ability to read, understand, and apply written and verbal instructions accurately.
- Excellent communication and interpersonal skills for collaborating with internal and external stakeholders.
Preferred Qualifications:
- Experience with MD-Staff credentialing software or similar platforms.
- Knowledge of NCQA compliance standards and delegated credentialing requirements.
Education
- Bachelor’s Degree required.
- Verifiable High School Diploma or GED required.
Work Requirements
- Fully remote – no onsite attendance required.
- Must have reliable high-speed internet and a quiet, distraction-free workspace (mandatory).
- Must be able to work Eastern Standard Time (EST) hours.
- Non–patient-facing role.
