Provider Enrollment Quality Analyst - Remote US

Summary

As a Provider Enrollment Quality Analyst - Remote US at Gainwell Technologies, you will support provider enrollment and provider revalidation operations by ensuring the accuracy, quality, and compliance of provider enrollment transactions, documentation, and operational processes. This role plays a key part in supporting Medicaid provider revalidation and fraud prevention initiatives tied to evolving federal and state healthcare compliance requirements.

You will partner closely with Provider Enrollment Analysts, Leads, Supervisors, and operational leadership to identify quality trends, support process improvements, ensure regulatory compliance, and maintain operational excellence within a high-volume healthcare environment.

Your role in our mission

• Conduct quality reviews and audits of provider enrollment applications, provider revalidations, maintenance requests, renewals, and supporting documentation to ensure accuracy, completeness, and compliance with CMS, ACA, state, and federal guidelines.
• Monitor operational quality standards, productivity trends, documentation accuracy, and workflow compliance while identifying deficiencies, root causes, and opportunities for process improvement.
• Review and evaluate provider-related communications, case documentation, and enrollment activities to ensure adherence to internal policies, operational procedures, and client service expectations.
• Prepare reports, analyze quality findings, communicate audit results, and collaborate with leadership to recommend corrective actions, training opportunities, and procedural enhancements.
• Support calibration sessions, quality initiatives, audits, training activities, and continuous improvement efforts while maintaining confidentiality and compliance with HIPAA and company security standards.

What we're looking for

• High school diploma or GED required; associate degree or additional post-secondary education in healthcare administration, business, or a related field preferred.
• 2+ years of experience in provider enrollment, provider revalidation, provider credentialing, healthcare operations, claims processing, healthcare compliance, or quality assurance within a healthcare environment.
• Experience performing quality reviews, audits, compliance monitoring, or quality assurance activities in a healthcare operations or production-based environment preferred.
• Working knowledge of Medicaid, Medicare, provider enrollment processes, provider data management, healthcare compliance standards, and regulatory guidelines preferred.
• Strong analytical, organizational, communication, problem-solving, and Microsoft Office skills, including experience with Excel, reporting tools, and web-based healthcare systems.

What you should expect in this role

• This is a fully remote position open to candidates located anywhere within the United States.
• Employees must be available to work Monday through Friday during Eastern Time business hours, from 8:00 AM ET to 5:30 PM ET, regardless of their local time zone.
• This role supports provider revalidation and healthcare compliance initiatives tied to evolving federal and state fraud prevention requirements.
• Daily productivity, quality, audit, and service level expectations will be monitored in this fast-paced operational environment.
• Harver Assessment Requirement: As part of the interview process, all candidates must complete the Harver Assessment, and video cameras must be used during interviews and orientation. Employees must also maintain a broadband internet connection with minimum speeds of 24 Mbps download and 8 Mbps upload for remote work effectiveness.

*This posting is intended for pipelining. We will accept applications on an ongoing basis.

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