Quality Assurance Analyst

Job description

Position summary
Conducts quality assurance reviews of IDRE case processing activities - reviewing case files, eligibility determinations, communications, and determinations for compliance with CMS requirements, accuracy, and PRI quality standards. Supports continuous improvement by documenting findings and tracking corrective actions.

Essential functions
• Conduct QA reviews of assigned IDRE case files - eligibility determinations, case documentation, and party communications
• Apply CMS IDRE quality standards and PRI quality criteria to assess case file accuracy and compliance
• Document QA findings clearly - identify the issue, the applicable standard, and the required correction
• Track corrective action completion for identified QA findings
• Provide feedback to operational staff and supervisors on identified quality issues
• Generate QA reports on error rates, finding categories, and trends
• Support CMS audit preparation - QA documentation and evidence compilation
• Participate in calibration sessions to ensure consistent QA application across the team

Minimum qualifications
• 1 to 4 years of quality assurance or compliance review experience - healthcare or IDRE preferred
• Knowledge of CMS IDRE requirements and No Surprises Act preferred
• Strong analytical skills - identifies patterns and root causes of errors
• Detail-oriented - reads case files carefully and applies standards consistently
• Clear written communication - QA findings must be specific, accurate, and actionable
• Ability to deliver feedback constructively to operational staff

As an EEO/Affirmative Action Employer all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status.

Benefits and Compensation Provider Resources provides a competitive benefits package that includes access to Medical, Dental, and Vision Insurance, Life Insurance, Disability, Health Savings Account (HSA), Flexible Spending Accounts (FSA), Critical Illness, Accident, Legal and ID Theft, 401k plan, PTO. The anticipated salary range for fully qualified candidates applying for this role will be above (not including discretionary bonus, equity, and benefits). The final salary offered will be dependent on several factors that include but are not limited to relevant previous experience including duration and type of experience within the industry, education, and internal equity.