Sr. Data Quality Analyst, PDM

Role overview

Lead efforts to improve the accuracy, integrity, and governance of provider data across its lifecycle, from contracting and credentialing through enrollment, maintenance, and termination. This role combines data analysis, operational process improvement, and cross-functional leadership to strengthen provider directories, support regulatory compliance, and improve member and provider experience.

Responsibilities

- Develop provider data quality standards, controls, metrics, and ongoing validation processes. - Analyze records, audits, monitoring results, and stakeholder feedback to identify defects, investigate root causes, and direct corrective action. - Support provider directory accuracy programs, track performance trends, and help prepare for audits, reporting, and regulatory or accreditation reviews. - Define provider data terms, business rules, ownership, and stewardship practices with business and technology partners. - Build dashboards and reports to show data quality performance and operational results; explain findings and recommendations to stakeholders and leaders. - Review provider operations from end to end and lead improvements that increase data accuracy and efficiency.

Requirements

- Five or more years in healthcare provider operations, provider data management, enrollment, credentialing, network operations, or a related field. - Three or more years leading data quality, governance, or integrity initiatives. - Experience with provider directory operations, provider lifecycle processes, root cause analysis, and corrective action planning. - Strong understanding of provider master data and healthcare provider workflows. - Proficiency with Excel, Power BI, and SQL for analyzing data and developing reports or dashboards; experience with Tableau or a comparable visualization tool. - Strong analytical, problem-solving, communication, and presentation skills, with the ability to translate findings into practical recommendations and manage competing priorities.

Nice to have

Experience with Quest Analytics, particularly network adequacy analysis; work in a health plan or managed care setting; support for CMS, NCQA, accreditation, or regulatory requirements; provider lifecycle platforms or data repositories; and data governance or master data management programs.

Benefits and work setup

The role requires availability during Pacific Time business hours. Employment sponsorship is not available.