Enrollment Quality Assurance Analyst

Network Health is hiring an Enrollment Quality Assurance Analyst to monitor enrollment operations, conduct audits, and ensure regulatory compliance. The role identifies quality gaps and trends, supports corrective actions and process improvements, and helps maintain accurate enrollment processes and service.

Responsibilities

• Demonstrate commitment and behavior aligned with the philosophy, mission, values and vision of Network Health
• Appropriately apply all organizational and regulatory principles, procedures, requirements, regulations, and policies
• Supports and regularly reviews department policy and procedure documents to ensure regulatory compliance, operational efficiency, and alignment with industry best practices; identifies gaps and partners with department leadership and/or trainers to implement process improvements
• Supports collaboration between enrollment and quality assurance staff to promote effective monitoring practices, ensure feedback is acknowledged, and errors are corrected
• Supports collaboration with compliance staff, regulatory contacts, and software vendors as high-priority questions and issues arise
• Supports tracking and trending of audit results to identify and pursue improvement opportunities
• Serves as a subject matter expert and key contributor for monitoring activities, including Centers for Medicare & Medicaid Services (CMS), Office of the Commissioner of Insurance (OCI), Model Audit Rule (MAR) controls, HEDIS audits, and Enrollment Data Validation (EDV)
• Identifies process gaps and partners with internal stakeholders to address and resolve them
• Provides accurate and timely reporting in accordance with department, regulatory, and business requirements
• Maintains knowledge of current state, federal, and industry regulatory standards and service expectations
• Communicates concerns to department leadership, including process issues, resource needs, and training opportunities
• Performs audits per department standards and partners with leadership and appropriate stakeholders to support root cause analysis and development of corrective action plans as needed
• Assists in monitoring department phone lines and email inboxes, helping coordinate staff coverage
• Performs other duties as assigned

Benefits

• Eligible to work at your home office (reliable internet is required), at the Brookfield or Menasha office, or a combination of both with the hybrid workplace model; candidates must reside in Wisconsin.
• Opportunity to get paid to volunteer in your local neighborhood.

Company

• Health plans and Medicare Advantage coverage for Wisconsin residents
• Menasha, Wisconsin, USA
• https://networkhealth.com/
• Founded in 1982
• 501-1000 employees

Qualifications

• Candidates must reside in the state of Wisconsin for consideration
• High school diploma or equivalent
• 2 or more years working in an auditing focused role required
• 2 or more years of experience in health care required
• 2 or more years working in an auditing focused role required.
• 2 or more years of experience in health care required.

Required skills

• Auditing

Experience

• 2+ years