QA analyst PEC - Great Location

Unclassified - Boston, MA

Full-time

Boston, MA

About the position

The QA Analyst PEC position is responsible for validating the quality of Provider Enrollment and Credentialing (PEC) activities. This includes reviewing PEC applications, conducting quality control activities, and ensuring compliance with company standards and regulations. The role requires close collaboration with PEC Specialists to ensure timely and accurate processing of provider applications, as well as providing assessment and trend reports to management. The position offers opportunities for growth in a professional environment.

Responsibilities

• Validate the quality of Provider Enrollment and Credentialing (PEC) activities.
• Review PEC applications and conduct quality control (QC) activities throughout the PEC process.
• Work closely with PEC Specialists to ensure timely and correct processing of provider applications in compliance with SLAs.
• Provide assessment and trend reports to management.
• Ensure compliance with company QA standards, regulations, and applicable contractual standards.
• Conduct QC activities related to application processing and data entry functions.
• Review applications for compliance with regulations, completeness, and accuracy of information.
• Validate documentation including licensure and ensure data entry is complete and compliant with EOHHS regulations.
• Identify errors with applications and data entry and ensure timely correction.
• Perform analysis and identify trends in the inspection of provider applications and data entry.
• Identify areas for Continuous Quality Improvement (CQI) throughout PEC processes.
• Ensure established service inspection, sampling, and statistical process control procedures are followed.
• Train staff to achieve or maintain quality assurance goals.
• Effectively communicate with all facets of the project to further quality assurance goals.
• Develop routine and ad-hoc reports.
• Perform other duties as assigned by management.

Requirements

• Bachelor Degree from an accredited college or university.
• 3 - 5 years experience working with MassHealth provider credentialing.
• 3 - 5 years of quality experience; experience with TQM, ISO, Six Sigma, or other quality management techniques and tools.
• Knowledge of PEC policies and procedures and EOHHS regulations.
• Excellent written and verbal communication skills.
• Ability to perform comfortably in a fast-paced, deadline and detail-oriented work environment.
• Ability to successfully execute many complex tasks simultaneously.
• Ability to work both as a team member and independently.

Nice-to-haves

• Experience with the MassHealth program provider services.

Benefits

• Great Location
• Professional Environment
• Room For Growth