Provider Network Quality Assurance Specialist

Alliance Health

. Monitor, audit, and improve the quality, accuracy, and compliance of provider network operations .

Posted 10/12/2026full-timeRemote • North Carolina • United StatesMid-LevelSenior💰 $69,592 - $88,729 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in quality assurance and improvement, with a strong focus on regulatory compliance and provider network operations. Proficient in data analysis and project management, ensuring accuracy and integrity in provider data and documentation.

Highest-signal resume keywords

Quality Assurance/ImprovementData AnalysisProject ManagementRegulatory ComplianceProvider Network Operations

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisQuality Improvement PlansRoot Cause AnalysisAudit Schedule DevelopmentContract VerificationExcel ProficiencyMicroStrategy ProficiencyDocumentation of Compliance GapsStatistical ModelingProcess Improvement

Soft Skills

Superior Communication SkillsStrong Organization SkillsTime Management Skills

Tools & Technologies

SalesforceAlliance Claims SystemMicrosoft OfficeExcelMicroStrategy

Industry Keywords

Managed CareDHB RequirementsNCQA RequirementsAccreditation ReviewsSocial Determinants of Health

About the role

Key responsibilities & impact

Monitor, audit, and improve the quality, accuracy, and compliance of provider network operations
Support provider data integrity, regulatory compliance, provider directory accuracy, and continuous process improvement
Conduct quality audits of provider network operations processes
Develop and maintain an audit schedule
Conduct research, analyze data, and recommend solutions for administrative, organizational, and operational problems
Maintain audit evidence and records for internal and external review readiness
Review provider directory accuracy and maintain documentation meeting DHB and NCQA requirements
Compare published information with source systems and coordinate outreach or research to resolve discrepancies
Prioritize corrections affecting member access, search results, or regulatory compliance
Perform root cause analysis, track corrective actions, and report results
Review provider data in Salesforce, Alliance Claims System, and enrollment and contracting systems
Verify contract terms, effective dates, network participation, locations, and reimbursement attributes
Identify and route missing, expired, inconsistent, duplicate, or incorrect information and track corrections through completion
Maintain audit criteria based on regulatory, accreditation, contractual, and internal policy requirements
Document compliance gaps, assess risk, and escalate significant findings
Support regulatory requirements, accreditation reviews, and internal compliance assessments
Partner with accountable teams to define corrective and preventive actions, owners, milestones, and due dates
Document all root cause analyses

Requirements

What you’ll need

Bachelor’s Degree in human services; Sociology, Psychology, Public Health, Statistics, Economics, Business Administration or related social science field from an accredited college/university
At least five (5) years of related experience providing quality assurance/improvement activities
Experience leading project teams focused on quality improvement projects
Excel proficiency required to analyze data and produce graphs and tables
Superior communication and writing skills
Strong organization and time management skills
Advanced knowledge of Microsoft Office applications, including Excel
Proficiency in MicroStrategy or other statistical or data modeling programs
Experience developing quality improvement plans for services to persons with complex physical health, behavioral health, and social determinant of health needs
Experience with project management processes
Ability to manage multiple projects
Ability to work with members, network providers, families, and government staff while considering cultural differences
Prior experience in Managed Care preferred

Benefits

Comp & perks

Medical, Dental, Vision, Life, Long Term Disability
Generous retirement savings plan
Flexible work schedules including hybrid/remote options
Paid time off including vacation, sick leave, holiday, management leave
Dress flexibility