Provider Enrollment Quality Analyst - Remote US at Gainwell Technologies LLC

, Ohio, United States -

Full Time

Start Date

Immediate

Expiry Date

22 Aug, 26

Salary

61600.0

Posted On

24 May, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Provider Enrollment, Quality Assurance, Compliance Monitoring, Auditing, Healthcare Operations, Data Analysis, Microsoft Excel, HIPAA Compliance, Problem Solving, Reporting, Provider Revalidation, Credentialing

Industry

IT Services and IT Consulting

Description

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. 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. #LI-LS2 #LI-REMOTE The pay range for this position is $43,100 - $61,600 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings. Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

Responsibilities

Conduct quality reviews and audits of provider enrollment applications and revalidations to ensure compliance with CMS and state guidelines. Analyze quality trends and collaborate with leadership to recommend corrective actions and process improvements.